■ eIIxIiKb 



— OInT 



PnbMedbyGEO. H. FIELD, M. D. 
ST. LOUIS, IV 



LIBRARY OF CONGRESS. 






Shelf JL&t 



UNITED STATES OF AMERICA. 



MILLER 



Being an Epitome, of its Origin, Cause, Mode of 
Production and Propagation ; its Pathology 

AND 

TREATMENT ; 

COMPRISING THE BEST TREATMENT OF 
ALL SCHOOLS, WITH A REVIEW OF 

THE SAME, ENDING WITH 

THE ACID, OR RATIONAL TREATMENT. 

BY 

„ J. A. MILLER- D. D-, M. D. 

7>V \ -T 

CALIFORNIA. 

17 \B\ 

KS>t-^x 



Published by geo. h. field, b. s., m. d, 

St. Louis Medical Journal Office. 

ST. XiOTJIS MO. 

1887. 



./I SA 



Copyright Secured. 
/885. 



INDEX. 



CHAPTER, I. 








HISTORY OF DIPHTHERITIS TTS ORIGIN AND PROGRESS, 


. page 1 to 9 


CHAPTER, II. 








THE ETIOLOGY OF DIPHTHERITIS, .. . 


14 

U 


9 


M 19 


Climatic and Atmospheric Conditions, • 


12 


CHAPTER, III. 








IS DIPHTHERITIS CONTAGIOUS ? 


t< 


19 


" 26, 


CHAPTER, IV. 








PATHOLOGICAL ANATOMY, 


it 


26 


t4 34, 


CHAPTER, V. 








DIAGNOSIS OF DIPHTHERITIS, 


Li 


34 


u 42. 


Differential Diagnosis, 


i. 




37, 


Suggestion, .. .... 


t ; 




41, 


CHAPTER, VI. 








PROGNOSIS, 


(t 


48 


n 46 


CHAPTER, VII. 




ALOPATHIC TREATMENT OF DIPHTHERITIS, 


t . 


46 


" 54 


CHAPTER, VIII. 




HOMCEOPATHIC FINDINGS IN DIPHTHERITIS, 


u 
a 


54 


" 70 


Symptoms, 


57 


Dangerous Symptoms, 


i l 




58 


Diagnosis, 


i . 




58 


Causes and Modes of Propagation, 


it 




59, 


Sequellae, 


u 




59 


Complications, 


u 




64 


Sequellae. 


u 




64, 


Special Indications, 


c 1 




^ 


Epitome of Treatment, 


u 




65 


Prognosis, . 


u 
u 

U 

a 




65, 


Local Treatment, 


67 


Convalesence, 


68, 


Preventive Measures, 


68, 


Therapeutic Hints,., 


69 



CHAPTER, IX. 

ECLECTICS AND DIPHTHERIA, 

Causes, 

Symptoms 

Treatment, 

Local, 

Description, 

Treatment, 

Symptoms, 

Treatment, .... 

Pathology, * 

Treatment, 

CHAPTER, X. 

RATIONAL TREATMENT OF DIPHTHERITIS. 

General Pathology, 

Rational Treatment, 

The Fever, 

Eruption, 

Paralysis, 

CHAPTER, XI. 

HYGIENE AND NURSING IN DIPHTHERITIS, 

Caution, ..: 

Diet, 

Nursing, 



1 1 


70 ' 


4 91. 


41 




77, 


u 




77, 


u 




78, 


a 




78, 


u 




80, 


ti 




81. 


1 i 




82, 


u 




84, 


1 t 




87, 


a 


87, 


1 (. 


91 " 


124, 


u 




103, 


u 




105, 


u 




113 


(t 




118. 


c 1 




119, 


(4 ' 


L24 c< 


129 


U 




124 


U 




125 


U 




126 



PREFACE. 



One of the best indications of progressive, intellectual 
advancement, is found in the fact, that the present generation 
is loosing all respect for ancient forms and usuages, demand- 
ing a careful scrutiny of the past, and an intelligent analysis 
of the present, with a rational basis for the future. This 
intellectual advancement in politics, is dethrowning Kings 
and overturning Empires, changing old methods of govern- 
ment, and carefully investigating any proposed new ones. 

The sciences of yesterday, are the ancient fables of to 

day — the religion of the past is unsatisfying to the inate 

cravings of the onward bounding, ever advancing present. 

In all the deductions of Earth, "excelsior," is the talisman, 

leading her enchanted hostess to higher altitudes of moral 
excellence. 

The science of medicine, begins to awake as from the 
somnambulism of ages. Young Asclepias shakes himself 
from the dust of antiquity and girds him for the race. Schools 
and pathies, old forms and fancies are left behind, and facts, 
are the demand of this intellectual, intensely rational age. 
The inquiry started by Pilot nearly nineteen hundred years 
ago, falls with a peculiar significance on the age in which 
we live, "what is truth?" 

Perhaps in no department of medical science, is inquiry 
more potent than in Pathology and Therapeutics. The eti- 
ology of disease is being investigated, Pathological Anatomy 



PREFACE. 

carefully studied, and Therapeutics is being brought to the 
practical test. Nothing is respected, or accepted as a fact 
because Galen, or Hippocrates announced it. 

The practitioner of to day, must see, feel, taste and know, 
for himself; and whatever cannot bear this test, must pass 
away as "The morning cloud and the early dew." This 
is as it should be. True, there may be here and there an ob- 
jector, but if facts are well established objections amount to 
nothing. The fact is the out growth of our intelligence, the 
objection the product of our ignorance, and must give way 
before the effulgent light of truth. 

In these pages there is no attempt made to advocate or 
condemn the "Germ Theory of disease" we accept the 
Germ Theory in the disease discussed, not because we deem* 
the theory as conclusively established; but because we find 
the facts exist, in this particular instance, and are conscious 
these facts cannot be intelligently called in question ; hence, 
because of these facts we accept them, and not because of 
existent theories.' ;i 

That the treatment advocated will receive criticism is ex- 
pected, let it be a criticism, however based on the practical 
test. The author holds himself ready to defend his position 
till convinced by demonstrated facts, of a better method, a 
more rational process/ and then he will ever be found ready 
to do homage to "the truth." 

Scorn, scoffs and sneers, are the arguments of fools, where 
tacts are wanting, and such arguments carry their own an- 
swer with them, hence, will receive no attention from me. 

I have written in the interest* of the public, and for the 
benefit of the. profession, and how far I have succeeded both 
must judge. ( J. A. M. 



CHAPTER, i: 



THE HISTORY OF ITS ORIGIN, AND PROGRESS 



Many years since a sacred writer declared, "The thing 
that hath been, it shall be; and that which is done is that 
which shall be done; and there is no new thing 1 under the 
sun." And these facts hold just as good in science and phi- 
losophy, as they do in moral ethics. It is self evident that- 
much the greater part of what we call "new," is only so to 
us ; and from this delusive appearance, we falsely conclude 
it must be so to all mankind. This conclusion retards in- 
vestigation, beclouds our judgment, feeds our vanity, and 
results in the perpetuity of error. 

Years ago the world became intensely interested in the 
application of hydrostatic force ; but anatomy demonstrated 
its application was as old as creation, and formed the essen- 
tial blastemia in the sustentation of animal life. 

The invention of the armstrong gun, awoke a worlds en- 
thusiasm ; how that enthusiasm was cooled, when it was 
found that heathen China, had been using all the essential 
principles of this gun for undefined ages. 

Morse's Telegraph commands the admiration of the world, 
and yet, in its most intricate combination, it is absolutely 
insignificant, when compared with the human nervous sys- 
tem ; showing its principles were old, long before Morse 
was young. 



2 THE HISTORY OF ITS ORIGIN, AND PROGRESS. 

This thought holds good especially, with reference to 
disease. Six thousand years of mundane existence has cer- 
tainly been sufficient to develop all the morbid combinations 
which may produce dise,ase. True, man may change his 
relations to surrounding circumstances, and thus develop 
fresh combinations and complications, and thus modify dis- 
ease, or, even add to it, previously, unobserved pathogenetic 
changes ; but the disease per se, from the very nature of the 
case, must be as old as the violated law which gave it paren- 
tage ; and as soon as the physical frame is placed in favora- 
ble relation to the morbid process the disease is developed, in 
perfect harmony with the natural law of cause and effect, 
controlling morbific influences and human susceptability. To 
illustrate, certain morbific combinations, the product of na- 
tures influences, always have, and always will produce certain 
formities, which being liberated from their parentage float in 
the atmosphere, and this atmosphere being inhaled by a hu- 
man being whose system happens to be in a favorable con- 
dition, Variola is speedily developed, with all its attendant 
consequences. 

Another variety of formities, produced and modified by the 
same law, deposited in an equally modified, but, genial soil, 
always have, and under the same conditions always will pro- 
duce Rubeola Vulgaris. These again modified by contingent 
circumstances developed Rubeola Mgar, while others, mod 
ified again by this same law of causation, produce Scarlet 
fever; Typhoid fever; Yellow fever; Cholera, &c, &c, ad 
infinitum. This, is simply the common law, governing the 
development and propagation of all zimotic diseases. 

If then, this is correct, and it is ; how absurd to regard 
Diphtheritis as a product de novo, of recent combinations 
which were only lately matured, when the law must be as 
old as posterity, and the combination which produces the 
forms, must be as old as the effete matter which gives rise 
to these exhalations, and devrlops these formities. It is 
true, these formities might float in unlimited space for all 
time to come without impervious effect, were it not for an- 



THE HISTORY OF ITS ORIGIN, AND PROGRESS. 6 

other class of phenomena. This world happens to be peopled 
with human beings who live to breathe, and who must breathe 
to live. Exposed to various climacteric morbific influences such 
as colds &c, the fauces become irritated, inflamed and abra- 
ded, still, respiration must go on and the individual breathes 
this atmosphere charged with these fortuities, which come in 
contact with that irritated mucous surface ; they form a lodg- 
ment, enter the circulation, attack and feed on red-blood 
corpuscles, destroy the plasma and Diphtheritis with all its 
local manifestations, and constitutional phenomena is de- 
veloped, as a natural result of this combination of morbific 
causes. 

Now to assume that six thousand years have passed and 
this combination of causes not occurred, until within the 
past few years, is not only petitio principi, but the culmina- 
tion of illogical absurditv. 

It is but reasonable to suppose, nay ! more ; it is but as- 
serting a self-evident proposition, to say that the first case 
of Diphtheritis occurred, when this natural combination of 
circumstance-, in harmony with natural law first took place. 

And it is equally reasonable to suppose that this combi- 
nation took place, even ages before its characteristics were 
noted, or, its history written, before ^Esculapius was born, 
or, Hygeia proffered her magic golden bowl to her eagle 
headed serpent to restore his health. 

Though the sifting sands of time have thus obliterated 
the exact period of the inception of this combination, which 
first produced this disease ; there are still finger boards left 
along the road, pointing its origin back, beyond, where chron- 
icles become obscure, and history fails to enlighten. If w T e 
thus trace it back and find it referred to anions: the earliest 
medical records, this is all that can be reasonably expected. 
As this seems to be considered by the public generally, and 
the profession in particular, as a new disease, I shall proceed 
further to expose this error. 

Five hundred and ten years before the Christian Era, while 
Babylon was yet in her glory and Cartharge sat as " mistress 



4 THE HISTORY OF ITS ORIGIN, AND PROGRESS. 

of the seas," when Rome was jet in swaddling bauds, and 
Thales had scarcely lit the first Ionic taper ; and Pythagoras 
was studying Astronomy; D" Hauvanture,& celebrated 
physician of India, gives us the first unmistakable descrip- 
tion of Diphtheria. Not, 'tis true, under its modern name 
but by the use of terms which unmistakably, apply to this 
disease, and could 'be used to characterize no other. 

Asclepiades, the Greek poet, philosopher and physician, 
is said, in this disease to have performed laryngotomy. 

But Aretoeus, of Cappadocia, gives us the first good de- 
scription of this disease, calling it, "Syriac Ulcer?' and so 
completely details its symptomology as to render its identity 
unmistakable. In fact nearly all ancient medical writer's, 
either alluded to this disease, or, gave a more or less accurate 
description of it ; thus showing clearly that it existed in their 
day, and as far as their facilities were concerned, its etiology 
was carefully studied and its treatment received their mark- 
ed attention. 

Coming down to a later period we find that in the year 
380, a. d., it prevailed as an epidemic in the city of Rome, 
and produced its most marked and fearful results. In this 
early day the methods of treatment were necessarily crude, 
empirical and uncertain, and its mortality was correspond- 
ingly augmented ; while Rome's slaughtered human heca- 
tombs would favor the augmentation of atmospheric combi- 
nations necessary to the development of blastemia, calcu- 
lated to produce the disease. It raged as an epidemic in 
Holland-, in 1337, and again visited that country as an epi- 
demic in 1557, and according to Von. Woerd produced the 
most alarming results. It again broke out in Danzig, Cologne 
and Augsburg in 1565, and Ballonius informs us thaUn 1576, 
there was an epidemic of this disease in Paris ; and very 
minutely describes the false membrane, which forms such a 
prominent manifestation of this disease'. 

An epidemic of this disease broke out in Spain, in the 
year, 1583; and again in 1611 ; a very excellent account of 
which, is found in the medical writings of Juan, de, Villa. 



THE HISTORY OF ITS ORIGIN, AND PROGRESS. 

Real; who took special pain's to collect all possible, reliable, 
information on the etiology of the disease, the modes of 
propagation, the methods of treatment, and the results. It 

•appeared in epidemic form in Italy, in 1618, and the medical 
literature of that country furnish an excellent account of 
the disease, its ravages, treatment &c ; and Wedel in 1718, 
refers to its existence in Germany. 

True, this leaves a long period in what is known as the 
middle, or, dark ages, in which no reference* -to this disease 
is found. But that is no evidence of the non-existence of 
the disease during that period. We have but, limited records 
of the most important national events during, that period ; 
and only enough to show .that the people were stupid in ig- 
norance, plunged into barbarism, and devoted to, the most 
cruel, foul, licentiousness. Literature was neglected, and 
the practice of medicine intradicted by law., ■ 

After the decline of Grecian literature, medicine as a dis- 
tinct science made little, or, no progress, i Superstitious 
ceri monies took the the place of pathological investigation, 
incantations superceded therapeutics, and the manes of 
the departed were invoked, to secure the recovery of the 
sick. To such an .extent was this the. case that during the 
warlike days of Rome, she was six hundred }'ears without a 

. single physician who made the healing art an exclusive study 
and practice. Pliny, tells us, that Aregathus (who by the 
way was the first to assume the appellation ** Regular") es- 
tablished himself at Rome, as a medical practioner ; at first 
the people received him with admiration and treated him with 
respect, and even reverance. But. so severe was his practice, 
and so unsuccessful its results, that disgust succeeded ad- 

. miration, and respect gave place to contempt ; till the citizens 
rose in their majesty, banished Aregathus from Rome, pass- 
ed the first quackery act, and Intradicted the practice of 
edicineby law. So much for the first "regular." 
In view of these facts,, this long period without medical 
reference to this disease, is not only,. not surprising; but is 
just what might have been expected. 



6 THE HISTORY OF ITS ORIGIN, AND PROGRESS. 

During the latter part of the days of Galen, the Roman 
empire began to decline, and the decline of literature and 
science in those middle ages succeeding, has left but limited 
records of disease, or remedial agents. In fact such was the 
character of the medical writings of that day, that Sprenzel 
declares, "The writers of the third and fourth centuries, 
were frigid compilers, being empirics, or, feeble imitators 
of the physician of Pergamos," meaning Galen. True, Ori- 
basius who lived in the fourth century, Aetius in the fifth, 
and Alexander Tral lianas and Paulus Aesjiria, in the sixth 
century, all wrote books on medicine ; but they professed 
to be but little more than mere compilations of, and com- 
mentaries on the works of Gajen ; while with the death of 
Paulinus, about the middle of the seventh century, termina- 
ted the career of the Greek school of medicine. The Ara- 
bians had conquered a large portion of the then, semi-civiliz- 
ed world, and in their conquest had destroyed the immense 
Alexandrian library, and with its distraction, Greece lost 
her interest in medical science, and record ; and Arabia came 
to the front as the exponent of the teachings and doctrins 
of the physician of Pergamos and his predecessors. Rhazes, 
of Iraek, Persia, in the ninth century, and Ali Abbas, in 
the tenth ; are in fact, the only prominent names in med- 
ical literature in any country during the period. The Ara- 
bians gave much more attention to conquest, than to the 
cultivation of the sciences ; hence, under their rule medical 
knowledge declined, until with the death of Averroes, in the 
twelfth century terminated the Arabian or Saracenic school 
of medicine. The reputation of which was largely promot- 
ed by the fact, that during the four hundred years through 
which it flourished, the whole of Europe was sunken, as 
stated, in a state of almost absolute barbarism. Medical skill 
and practice was left to Monks and Friars, while the world 
went mad over Alchemy, which being persued in connection 
with chemistry, materially assisted in laying the foundation 
of a mineral practice. 

With these facts before the intelligent reader, he will not 



THE HISTOItY OF ITS ORIGIN, AND PROGRESS. 7 

he surprised at the lapse of this long period of absolute silence 
respecting not only this hut nearly all other diseases; nor 
he astonished at the fact, that when an epidemic reappeared 
in the thirteenth century, it should he deemed a "New dis- 
ease," and its history should be regarded by superficial in- 
vestigators as commencing at that date. It is, however, 
believed, that sufficient has been said to correct this error, 
and convince the public in general, the medical practitioners 
in particular, that this zymotic disease, has existed at all 
times, and in all countries, where the combinations, and con- 
ditions, were favorable for its development and propagation ; 
and that it will continue just as long as these favorable 
conditions continue to exist. 

In 1 659, the first epidemic of this disease occurred in North 
America, and is recorded by Sibly, vol. 1 page 94. 

He evidently failed to recognize its cause, comprehend 
its pathology, or understand any of its attendant phenome- 
na. He simply informs us that a number of children "died 
from bladders in the throat, or windpipe. From this date, 
various references, mostly imperfect, to this disease are 
found in nearly all medical writings of American authors. 

in 1747, an epidemic of this disease occurred among the 
settlers in New England, while it appears to have been en- 
demic to their settlement, it was epidemic among them. 

In 1752, it broke out among the swiss of the same states, 
and raged with considerable violence, carrying off quite a 
large number of children ; and in 1755, the swedish popula- 
tion of the same states were subjected to a similar visitation. 

Among the various writers of the last half of the ei^'h- 
teenth century, Home, a Scotchman by birth, who wrote 
in 1755, and Mr. Bard, an American, whose papers, on this 
disease appeared in 1789, deserve special mention as both 
had a marked tendency to call public attention to the dis- 
ease Mil \ thus excite medical interest in its closer investiga- 
tion. 

What may justly be called the modern history of this dis- 
ease begins with the appearance of Bretonueau's, first paper 



* THE HISTORY OF ITS ORIGIN, AXV PROGRESS, 

ou the subject, in 1821. He termed it "Angina maligna, 1 * 
and thought it identical with membraneous croup. He gave 
the matter considerable attention, studied the false mem- 
brane, and noted its effects in the nose, pharynx, and respi- 
ratory tract, and refers to the exanthemata which is its fre- 
quent attendant, and supposed this to be merely some morbid 
process of the skin. He claimed that it was a distinct dis- 
ease and, should not be confounded with catarrhal, or, scar- 
latinal inflammation. He regarded it as exclusively local ; 
but modified this opinion in his papers of 1825, when his 
complete monogram was published. Since then, the country 
in various localities, has been visited by this disease, endemi- 
eally, and epidemically, while perhaps the severest epidemic 
that has ever occurred, was that which visited the province 
of Kadakoff, Russia, in 1878 — 3, in which over 80,000, 
children, are supposed to have perished. 

Since the appearance of Bretonneau's monogram in 1826,. 
the literature of the disease has multiplied, year by year; no 
two writers hardly agreeing as to its etiology, pathology, 
or, the necessary remedial agents with which to successfully 
combat the entire morbid phenomenon. It is indeed, much 
to be ferreted, that so few medical men become real inves- 
tigators of the pathogenetic influences, which surround us, 
or, the etiology of disease, when once developed, the path- 
ological condition, when in disease, or the remedial agents 
which successfully combat and remove the morbid blastemia 
from the system. This lack of careful analytical investiga- 
tion, is the prolific cause of the multitudenous theories pro- 
mulgated on nearly all the medical sciences ; and largely 
form the basis of the acrimonious, altercations, which dis- 
grace the literature of the medical profession. Uncertainty 
is always verbose and dogmatic, and ever must be, to give 
it an air of authorit}^ — demonstrated fact, as above, can af- 
ford to be simple and unassuming, as its merit is its real 
commendation. 

There is true philosophy, as well as poetry in the stanza 
of our poet. 



THE ETIOLOGY OF DIPHTHERITIC 9 

"Truth crushed to earth will rise again, 

The eternal years of God are hers; 
While error wounded wryths in pain 

And dies, amid her worshipers." Bryant 

The only trouble is, it lives sumptuously , and flies rapid- 
v. and dies so slowly. 



CHAPTEK, IL 

THE ETIOLOGY OF DIPHTHERITIS. 

On this point, is where the perplexing confusion com- 
mences, each writer has seemingly a theory of his own, and 
if he explores the domain of etiology at all he seemingly ex- 
plores it only to find facts, or, fancies to sustain this theory. 
If the views of others are examined, their supposed errors 
are seldomly combated by better authenticated facts, scien- 
tific reasoning, or philosophical deduction. The ancients 
are scoffed at and moderns passed over in sullen silence, or 
•contemptuous indifference, and dogmatism takes the place 
of analysis, and arrant assertion the place of well authenti- 
cated facts. 

One declares it to be the product of " blood poisoning, 
hence constitutional;" another equally learned, and corres- 
pondingly certain, is sure it is ** purely local," and the con- 
stitutional disturbance is merely the sequence of local lesion,. 
Another is certain a "germ produces the disease ;" while 
still another is just ascertain that the "disease produces the 
germ." 

It is thus, that the literature of the disease becomes a 
tangled web of glaring paradoxes ; creating public distrust, 
and professional uncertainty ; which has caused the sacrifice 
of more lives, by this one disease than all other causes com- 
bined, and is only exceeded by the worse confusion in the 
remedial agents employed for its attempted cure. 

And this contradictory confusion is not confined to a con- 
flict between schools, but is characteristic of all schools, and 
is mostly found among different writers of the same school. 
Thus, one homoeopathic writer asserts, "Diphtheria is not 



10 THE ETIOLOGY OF DIPHTHERITIS. 

contagious, * * * there is no evidence that it ever was 
conveyed by formities" (C. Herring,) another, standing 
equally high, informs us it is caused by, "Impure air, from 
imperfect drainage, living too near the manure-depos : its, 
slaughter-houses, or where animal substances are in a state 
of decomposition. It commonly occurs as an epidemic, and a 
solitary case may prove a focus for spreading the disease", 
(Ruddock.) 

If as Herring asserts it has never been "conveyed by germ 
producing elements," i. e. "formities ," then how can it be 
produced by "impure air," as stated by Ruddock ; or, can 
impure air produce it without germ producing elements? If 
so, it would certainly be interesting to know what the pe- 
culiar bialytic in this impure air is, which is so distinctive 
of early life in the human race. An "impure air," without 
germ producing properties ("formities" ), is certainly a fla- 
grant paradox, which we shall make no attempt to reconcile. 
While the paradoxes and contradictions in the Alopathic 
school are more intense and no less flagrant. The real in- 
vestigators have been few ; but opinions have multiplied and 
contradictions abounded, till almost every medical journal 
has been made the medium of conveying these undigested 
paradoxes to a reading public, or, an inquiring physician, 
".making confusion worse confounded." As illustrative of 
this fact, let the reader consult at his leisure, Bretonneau, 
Bahr, Cheyne, Curtis and Satteithwaite, Eberth, Gay, 
Greenhow, Gubler, Jacobi, Mackenzie, Trendelenburg, 
Virchow, or any two writers of this school, on this disease, 
and he will be compelled to conclude that its causes are as 
multitudinous, as the writers themselves. 

The germ theory, however, started by the now despised, 
John Buchannan of Philadelphia, in 1851, adopted by Koch, 
of Germany, and extensively propagated through Europe, 
and on this continent, is gradually gain ins: ground, being em- 
braced by the most prominent men of this school, is gradu- 
ally harmonizing the conflicting theories of etiology, and 
may yet result in a scientific demonstration in this direction. 



THE ETIOLOGY OT DIP1ITIIETIITIS, 11 

That bacteria are nearly, if not always, present in the dis- 
ease now admits of no question. Will some solon demon- 
strate whether the bacteria? prodeuce the disease, or the 
disease produce the bacteria? Don't give us opinions please, 
we have plenty of them, it is facts we want. Facts, gen- 
tlemen if you please. 

In eclecticism, the investigators are few, hut theory con- 
structors are abundant and equally paradoxical, while their 
paragon of "specific medication," is abundantly contra- 
dictory and strangely inconsistent. We are thus compelled 
to turn from the jargon of schools, give the results of our 
own investigation and sustain, it by the investigation, of 
others who for years have made its causation a matter of 
special study. 

"Rational Medicine," is not only, "the light of the pro- 
fession," but it is also, the hope of the world, and with- 
out it all else is "sinking sand." One of the most hopeful 
signs of the times, is that here and there, in all schools, 
men are begining to lay aside prejudice, ignore "pathies," 
and nobly struggle to attain a Rational platform. All hail, 
brethren when we meet on this high plain we shall see tiie 
rising sun of the medical millenium. Alopathy, homoeopathy 
and eclecticism shall he no more, we will simply he physi- 
cians, devoted to the healing of the Nations, 

This disease, though largely a disease of childhood, is 
not absolutely so. In the epidemic of 1868, in Vienna, of 
500 deaths ; one had reached the age of sixty. The worse 
cases I have treated in this state, were among adults. My 
experience is that when adults are attacked with this disease, 
it generally assumes the malignant form. 

Sex, seems to exert no special influence either for, or 
against its propagation, or modification of its virulence. 

The greater tendency im childhood to this disease is easi- 
ly explained by the narrowness of the pharynx, and the 
greater sensibility of the mucous membrane of the fauces, 
combined with greater protuberance of the tonsils, the large 
number and size of the lymphatics, and their greater com- 



12 THE ETIOLOGY OF DIPHTHEKITIS. 

mun inability with the system at large. Dr. Ernst incidently 
suggests that "the free acid secretion of the mouth after the 
third month, tends to hinder its occurrahee sifter this period.'* 
If this is a fact, and it is, would not a further development 
of this acid secretion, by proper remedial agents, succeed 
in preventing it altogether? Is it not passingly strange, that 
our most profound investigators, should not profit by such a 
plain, natural suggestion ; and not continue to use alkalies as 
prophylactics and remedial agents, and thus perpetuate child 
hoods natural susceptability to this disease, and yet this is 
just what the great mass of medical pratitioners throughout 
the world are doin<>\ But more of this further on. 

CLIMATIC AND ATMOSPHERIC CONDITIONS. 

It appears that this disease is more common in temperate 
climates, diminishing, or disappearing as we approach the 
tropical, or the frigid zone. It appears that as far as climatic 
influences are concerned, that moisture favors the develop- 
ment of and is essential to its propagation. 

In California, as far as I have been able to ascertain, an 
epidemic of this disease ;ii> always been preceded by a 
South, South-east, or, South-wesi wind, accompanied by 
rain. It, by some has been supposed that this poison can lie 
dormant for along time, till some special agency calls it into 
active existance. My opinion however, is, that this is not 
the fact, but as soon as the atmospheric agency liberates 
these fortuities from the combinations which produce them, 
they at once start on their mission of death ; if they come 
in contact with an abraded mucous surface, the disease is 
developed ; failing in this, climatic changes may also effect 
their distinction. In this state, this disease prevails most 
extensively spring and fall, more in the former than the 
latter ; when changing temperature is producing catarrhal 
conditions, thus placing the mucous membrane in a favorable 
receptive condition. 

An examination of the membrane, or, the blood, affords, 
and can afford, no etiological information. These demon- 



THE ETIOLOGY OF DIPHTHER1TIS. 13 

strate the pat ho logical condition, but are of no value etio- 
logieally. These microcosms found in the membrane and 
the blood simply show the diseased condition of the patient, 
they are of no moment as to the mode, or, cause of their 
production. It is in ('act much to be regretted that medical 
writers should have overlooked this fact and confounded 
these two conditions, which are so essential^ distinct. 

For some years it was regarded as a disease of filth, 
exclusively it was supposed to attack those only, who were 
living under bud hygienic regulations. 

Further investigations however, have demonstrated that 
this is not the fact. It is now found that filth exerts little or 
no influence in its propagation, or prevention. The high and 
low; the rich and the poor; the fastidious and the filthy, 
are all alike subject to this disease. When the favorable 
atmospheric and patholagical conditions, exist, and come in 
contact, hence, the child of the Queen, and the lowly peas- 
ant arc stricken down in the same epidemic, and each find 
their final relief in the common grave. 

Thus, social possition secures no immunity from its rav- 
ages; but bad hygienic surroundings will no doubt increase 
sporadic cases; so that sewer- gass and filthy habits, while 
they may not originate the disease, form at least a favorable 
media for its perpetuity and propagation, when once formed. 

I am not aware that any of the ancients ever made any 
attempt to ascertain the nature of the diphtheritic poison. 
In fact in the absence of facilities, it would be quite imposs- 
ible for them to make any progress in this direction. It is 
only, since the introduction of the microscope that intel- 
ligent progress in etiology has been made. 

In 1840, Henle announced his belief in a "contagium vi- 
vumt" and shortly after Bihr, found wh-it he termed 
"schizomy cites" in diphtheritic membrane. I myself found 
spores, or, microcosms in this membrane in 1845, and at 
the time, erroneously concluded it of vast etiological impor- 
tance ; but further investigation revealed the f alicy of this 
conclusion. The existance of microcosms in the membrane 



14 THE ETIOLOGY OF DIPHTHLTIS. 

or, in the blood furnish no answer to the question, how did 
1 hey come there ? Are they the productive cause of 1 he dis- 
ease, or is the disease productive cause of them? Are they 
the same formitie- found floating in the atmosphere, prior 
to the develop ment of the diphtheritic phenomena? and 
if so, when, where, how and what, metamorphosis have 
they undergone in order to assume their present existing 
form? All these questions must be intelligently answered 
before we can assume their etiological signify cation in this 
disease; and as far as I have been able to ascertain, no at- 
tempt has ever been made by any investigator, to answer 
these important interrogations, and to their answer we shall 
now direct our attention. 

In an epidemic of diphtheritis in the San Joaquin Valley 
in 1881, in tracing up this disease to its source, it was found 
to have first occurred among the children of a family who 
kept a slaughter-yard, they had a surface sink in their kitch- 
en, the refuse from which, passed through the wall, and 
was discharged just out side. Hogs and ducks had free ac- 
cess to this, and had formed a Avallow at least thirty feet 
square, there was a pit under the house designed as a cellar 9 
and was without walls, or, floor; the effluvia from this cess- 
pool had concentrated in this vacuum to such an extent that 
I found it quite impossible to endure the smell. 

To add to this malarious, or deleterious influence, the hogs 
Avere fed in immediate proximity to the house, with the of- 
fall from the slaughter house, the family became offended 
when I called their attention to these existing facts. I was 
promptly dismissed, and another physician employed. They 
lost their four children, and came .near loosing their own 
lives. The next case occurring in the above neighborhood, 
was a near neighbor of the above family, they had a sink 
in the house with a waste-pipe passing through the floor into 
a barrel, this barrel had been allowed to till, run over, and 
hogs, ducks and geese, had formed a large wallow in its im- 
mediate proximity, their babe was taken first with the dis- 
ease and died, the other two children were then taken. I 



THE ETIOLOGY OF DIPHTHEEITIS. 15 

was called, had the place cleaned and disinfected, and though 
the attack was malignant succeeded in saving both their 
other children. While attending on these I had what I deem- 
ed, and still do, a fine opportunity of studying the etiology 
of this disease, as nearly as possible, uninfluenced by previ- 
ous investigations, or investigators. I found a large amount 
of fungus formation in the form of mould, attaching itself 
to the under side of the floor, most abundant in close prox- 
imity to the barrel, on examining it under a microscope of 
500 diameters, I found it abounding in micrococci. With this 
I vaccinated the fauces of the common domestic fowl, and 
in three days he died with well marked diphtheritis, the 
membrane of the throat presenting the same phenomena, as 
membrane taken from the throat of the child which had died 
in the above family. Not satisfied with this, I procured more 
of the fungus and vaccinated the throat of a cat, three months 
old — kept, it in a room to watch results. Next morning I 
found my kit lying round quite indisposed, languid, and ap- 
parently unwell ; its pulse accelerated and pupils dilated, by 
three o'clock in the afternoon, the mouth and throat were 
quite inflammed, by six o'clock p. m., the membrane had 
commenced to form, and next morning puss was dead. The 
membrane under the lense of the same microscope exhibit- 
ed a great abundance of bacteria ; while twenty three of 
these same micrococci were found in a drop of blood taken 
from the left ventricle of this kitten. Now from this, we 
have clearly the following facts. 

I. The fomities which constitute the essential blastema 
of this disease, is found in connection with a peculiar con- 
dition, of decomposing animal and vegetable matter. 

II. Peculiar states of the atmosphere are essential to the 
liberation of these fomities, from this decomposing material. 

III. The atmospheric conditions most favorable to their 
liberation, are the conditions of the atmosphere most favor- 
able to the development of irritation and inflammation of 
the fauces in the human throat. 

IV In the act of respiration, these fomities come in con- 



16 THE ETIOLOGY OF DIPHTHERITIS. 

tact with the irritated mucous membrane, form a lodg- 
ment, increase the irritation, and cause an exudation of 
plastic lymph, thus forming the membrane characteristic of 
this disease. 

V. Passing beyond this, they enter the circulation, and 
set up the peculiar pathological condition, always present in 
this disease. 

VI. The fo mities in the atmosphere, become the bacteria 
in this disease, and are perse, the essential productive cause 
of it, and all its attendant phenomena. 

These etiological conditions are not the result of a hasty 
analysis, or superficial investigation. 

These two cases of the fowl and kitten, are simply as il- 
lustrative, of a series of similar experiments conducted 
during a period covering nearly, forty years, and for many 
years past, with the same unvarying results. I am thus by 
the logical force of facts, compelled to these conclusions, 
and shall adhere to them till clearer facts expose the error 
of the process, or the deductions based upon it. 

The investigations of Klebs, Ortel, Eberth, Oeth, Curtis 
and Satterthwaite, Weisgerber, Peris, &c, &c, were all con- 
ducted before the present advances were made in micology, 
and the present precise methods were employed, as were al- 
so my earlier experiments, hence, were less perfect, and 
not as conclusive as more recent investigations. 

TTood and Formad, representatives to the National Board 
of Health in 1882, in a memoir on diphtheria, in appendix 
kt A" directly sustain these conclusions, and Soeffler, (Mitt, 
a, s, Kais Gesund, 11, 1884,) does the same thing; and Dr. 
Ernst, whom I quote more readily, he being of the "strict- 
est sect of the pharises" (i. e, Aleopathic school) says : "The 
latter is of the greater value, because the experiments were 
under the supervision and after the method of Koch ; than 
whom there is no greater living micologist. 

The experiments were made upon various animals and in- 
vestigations were carried out upon the human race. 

The results are as follows : 



THE ETIOLOGY OF DIPHTHERITIS. 17 

Two kinds of organisms were found, one a micrococcus, 
the inoculation of which produced lesions similar to erysip- 
elas, and bacillus situated in the deeper tissues, growing well 
at 28 C. (68 F.) on a cultured medium of blood-scrum, meat 
broth, peptone and grape sugar. The conclusions of Soef- 
fier's paper, are summed up as follows : 

"The organisms were not discovered in evory case ; but 
this may be explained by supposing their elimination during 
the course of the disease as occurs in the case of other path- 
ogenic bacteria." 

The most casual reader, however will observe that this 
conclusion of Soeiher, with all his other conclusions have no 
practical value as to the etiology of this disease, they have sim- 
ply and exclusively a pathological bearing. It may be, and, 
indeed is interesting to know how these microcosms may 
be cultivated, and the material on which they may feed and 
live, after they are once developed. It is more important 
to medical science, however, to know ?iow, they are develop- 
ed, and more interesting to a sufferer, to know how they 
may be destroyed when thus developed. Pathology, alone 
deals with them when found to exist. Etiology, seeks the 
cause of their existance ;#andn'n this particular, these investi- 
gators fall short. Hence, while they are useless as etiologists 
I shall use them when I come to consider the pathology of 
the disease. 

T am not aware that any investigator has ever before, 
made any attempt to show that the microcosms found in the 
membrane and blood of a diphtheritic patient, was the pro- 
duct of the fomites floating in the atmosphere, or, that 
these fauna were thus developed by the decomposition of 
animal and vegetable matter. 

This explains also why a moist atmosphere must preceed 
an epidemic of diphtheritis. Moisture being essential to the 
liberation of these fauna from their parentage, and be- 
ing lighter than atmospheric air ; when thus liberated, rise, 
and are carried by currents in the direction of the prevailing 
winds. Coming in contact with the favorable abraded sur- 



18 THE ETIOLOGY OF D1PH TH^RITIS. 

face, they form a lodgement, originate, so to speak, a colo- 
ny. Alkaline secretion being the natural element in which 
these systoblasts dev elope, and form the advanced spore 
found in all diphtheritic patients, which I have ever exam- 
ined ; and I have examined the membrane and blood of some 
hundreds of patients. 

To me, it was, and still is surprising, to find such men 
as Klebs, in the International Medical Congress of 1883, as- 
cribing this disease to the specific action of bacillus and Soef- 
fler's investigation leading to the conclusion, and the con- 
gress accepting this as the finale of etiological investigation 
in this 'direction; when important as the results are, they 
have no etiological bearing whatever. 

That they exist in the disease we fully admit, but so does 
the false membrane, so does the fever, so does the asthenia 
and the comparative asphyxia; but neither one of these, eith- 
er separate, or, combined, form the phenomenon which we 
designate diphtheria, or account for its productive cause. 
The true etiology of the disease must account for the pro- 
duction and development of these bacillus in the human 
body rather than the mere fact that they are found to exist 
in this diseased conditon. As the disease might develope 
them, instead of their developing the disease, and in that 
case, what would the etiology of these learned, patient, in- 
vestigators amount to? Verily, nothing. 

Again, whether diphtheritis is a local, or a constitutional 
disease, has occupied a larger space in medical literature, 
and discussion, since Bretonneau's paper appeared in 1821, 
than any other phase of this disease. 

If the time spent in this discussion, had been demoted to 
intelligent investigation of its true etiology, development or 
cure, many of the existing paradoxes would never have ap- 
peared, and scientific advancement would have been made, 
permanently settleing those points, and developing a Ra- 
tional mode of cure. 

If our conclusions are correct, and we think they are, this 
point is forever put to rest. The local lesion is simply the 



IS DIPHTHERLTIS CONTAGIOUS? 19 

point of entrance, and the constitional disturbance the evi- 
dence of the general diffusion of the Virus. 

It should also be borne in mind, that even Bretonneau, in 
his monogram of 1828, materially modified his view as to 
its being merely a local disease ; while Harrold, C. Ernst, 
whose facilities for observation were far superior to Breton- 
neau's, thus concludes ; "If, however, as seems probable, it 
is excited by some form of bacterium the question is settled, 
that the local manifestations are the signs of the place of en- 
trance, and the constitutional disturbances the evidence of 
the general distribution of the poison." While a few pre- 
judiced alopaths might object to findings of a Rationalist in 
medicine, however, well sustained, by the stubborn logic of 
fact, they will be slow to object to the conclusions of one 
so eminent in their own school. 

CHAPTER, III. 
IS DIPHTHERITIS CONTAGIOUS. 

In Europe the term "contagious," is used as a synonym 
with "infections," and as such, these terms are interchang- 
able among medical writers generally. How a disease can 
be contagious without being infectious, or how infectious 
without being contagious, may not at first sight appear to the 
ordinary reader ; and yet a marked distinction is maintained 
by most American medical writers. 

True, a disease cannot be contagious, without being in- 
fectious; but it is certainly just as true, that a disease may, 
in a certain sense, be infectious and yet not contagious. 

Every disease must be individually infectious, but every 
disease is not therefore, necessarily contagious. 

Cowpox virus, is intensely infectious to the individual 
vaccinated with the rotten putrid mass ; but it is not conta- 
gious, unless well charged with syphilitic virus, and then, 
it may become contagious, and be transmitted to wife and 
children. 

So while this distinction may not always be apparent, it 
is in many cases nevertheless real. 



20 IS DIPHTHERITIS CONTAGIOUS? 

We use the term contagious to characterize diseases 
which are spread by contact with their productive cause ; 
we use the term infectious to characterize the introduction 
into the human system of this contagious matter; and in 
this sense the contagious character of Diphtheritis is un- 
doubted. But even here, we have to qualify this statement. 
True, the contagious matter may be communicated directlv 
by the patient; but it is just, as true, that a party may be 
indefinitely exposed to all the exhalations arising from this 
same patient, and yet not take the disease. Hence, the infec- 
tious material of this contagious disease, must find a genial 
soil in which to develope the disease, or else the infection 
becomes inert, and the contagion does not spread. 

Consequently, this fact alone, should long since have in- 
voked medical attention, prevented contamination and ren- 
dered an epidemic a physical impossibility. The great trou- 
ble lies with the people themselves ; they will pay to have 
a disease cured, but will not to have it prevented. Hence, 
physicians are slow to investigate, and circulate for nothing, 
that which will take the bread and butter out of their own 
mouths; and who can blame them? 

That these fauna, constitute the essential blastema of 
diphtheritis, are abundantly multiplied by the discharges and 
exhalations from a diphtheritic patient admits of no donbt, 
and that they cling to solid bodies, and may thus be carried 
for an indefinite distance is equally certain; and if inhaled 
by parties who present an unfavorable soil, contamination 
will not take place; but if favorable, inside of forty-eight 
hours the disease will be developed. 

Now if this is so, and it is ; then we have to consider the 
conditions favorable to the development of this disease. 

As far as I have been able to observe decomposing animal 
or vegetable virus, singly, will not produce the blastema 
essential to beget the disease, they must be combined. Hence, 
a hog wallow, a duck pond, a sink discharging in a barrel, 
or above ground, or under ground, but allowed to become 
filthy, drains and sewers in the same condition, are all fa- 



IS DIPHTHERITIS CONTAGIOUS? 21 

vorable conditions for the germination of fauna. In fact 
-duy of the conditions which are favorable to the production 
of typhoid fever, appear to be favorable to the origination 
de novo of this disease; the one attacking the patches of 
Peyer, the follicles of Lieberkuhn, and the glands of Bruner, 
the other attacking the glands of the throat. My convictions 
are, that the causes are identical, the variation in the disease 
being caused by the peculiar pathogenetic condition of the 
individual. The one prior to the reception of the conta- 
gious infection, suffering from an irritation of the fauces, 
the other suffering from some morbid irritation of the intes- 
tinal tract, especially those patches, glands and follicles. 

That this disease sometimes affects domestic animals there 
can be no doubt. Hence, Power, in the British Medical 
Journal Feb. 2, 1879, refers to the milk of a diseased cow 
as the origin of this contagion. 

Dennau, in 1876, traced it to diseased animals infected 
with a similar, if not the same disease. Brignon, Blazekavie, 
and Bollinger, all do the same. Several quite eminent writ- 
ers have observed that in an epidemic of diphtheritis, as a 
general thing the domestic cat is effected by a similar disease, 
I have passed through quite a number of epidemics of this 
disease, but this fact has never attracted my attention, as I 
have always been more interested in the human subject, 
than in the domestic cat. But from the etiology of the dis- 
ease, I am disposed to doubt this stated fact. 

While I even doubt its existance in animals, and incline 
to the opinion that an epizootic characteristic of animals may 
develope the fauna which are the blastema of this disease, 
and the climatic influences which drvelope this epizoo in an- 
imals would be pre-eminently calculated to beget irritation 
in the fauces of children, and thus form a genial soil for the 
lodgment of those fauna, and thus develope this disease. 
So that both occurring at the same time, and having much 
in common, it was easy to fall into the erroneous conclusion 
that these two were identical ; while a closer examination 
would show that inessentials they were as wide apart as the 



22 IS DIPHTHERITIS CONTAGIOUS? 

poles. Thus the exudation in the animal is mucous, or mu- 
co-purulent ; the exudation in the human subject is plastic 
tymph. The exudation in the animal is the sole result of 
local irritation, and will form no continuous membrane, but 
is discharged as muco-purulent matter. The exudation in 
the human subject is at least augmented by the constitutional 
disturbance, and the plastic lymph forms a continuous mem- 
brane. The febrile reaction in the animal is continuous. 
The febrile reaction in the human subject is generally in- 
termittent. In the discharge from the mouth and nose of 
domestic animals, I have failed to find the characterie bac- 
teria. In the blood and membrane of the human subject I 
have always found these present and multiplied just in pro- 
portion to the violence of the attack. These facts with many 
others have long since lead me to the conclusion, that while 
the two diseases may, and generally do exist, the one in the 
animal and the other in the human subject at the same time, 
they are not by any means one and the same disease. As 
climatic influences are the sole cause of the one, and cli- 
matic influences alone, are not sufficient to produce the 
other. 

That the disease in cattle, from a concatenation of causes, 
may produce the fauna of diphtheria, appears quite possi- 
ble; infact is very probable ; while it is equally evident that 
this is the only relation these two diseases sustain to each 
other. Neither can I see how the milk from a diseased cow, 
alone can generate the disease ; as Soeffler found that the 
application of the fully developed microcosm, "to a healthy 
mucous membrane, gave no results.'' The microcosms 
found in diseased milk, are much more likely to develope 
Typhoid fever, than diphtheritis. In fact I have frequently 
found it develope the former, but never the latter. I have 
never tested the matter, but have reason to doubt, whither 
the direct application of the full developed bacteria to the 
abraded mucous surface, would produce true diphtheritis. 
From its very nature, it would be much more likely to pro- 
duce Erysipelas. Soeffler, again tells us, that, "Two kinds 



IS DIPHTHEKITIS CONTAGIOUS? 23 

of organisms were- found" (in diphtheritic membrane) "one 
9 micrococcus, the inoculation of which produced lesions 
similar to erysipelas." 

One thing is certain, the distribution in the atmosphere 
of fauna, is the ordinary way of propagation. 

I have no inclination to speculate on the possibilities of 
other methods, lam absolutely certain on this. Soeffler agrees 
with Klebs, in ascribing a specific "action to the bacillus 
found in this disease" but stops where, I think I found the 
origin, mode of propagation, and point of entrance, not 
of the bacillus, but of the systoblast, which when in contact, 
with ;in alkaline secretion, develops this microcosm found 
by these investigators, as such a prominant feature in the 
special pathology of this disease. 

If then, the fauna which produce this disease, may be 
generated by the excretions from diseased animals, this 
would explain the origin of the disease in human beings, in 
which the source of the infection was obscure, and inex- 
plicable. 

We might here dismiss this part of our subject, were it 
not for the frequent assertions made and circulated through 
the Medical Jounfals of the country. "That all talk about 
it being an infectious disease, is silly twaddle and non-sense." 
"There is not a solitary instance on record of diphtheria 
ever being carried from one town to another," &e, &c, &c. 

It would seem but just, for such writers to inform us how 
a wow-infectious disease, becomes epidemic, at all. 

True, an epidemic disease, is one which, from a general 
defusion of its cause, affects numerous persons at the same 
time; but how could it do this, and not be infectious? Echo, 
alone answers, "how?" I fear, "That all such talk about 
its being a wow-"infectious disease, is silly twaddle and non- 
sense ;" for how, even the general distribution of a wow- 
infectious cause, can produce an epidemic disease ; if not a 
paradox, at least, is not by any means clear to ordinary com- 
prehension. In fact it is not only a paradox but according 
to the strict use of language is the culmination of absurdity. 



24 IS DIPHTHERITIS CONTAGIOUS? 

In fact "epidemic", has, and always must have, "infection", 
as its predicate for without it cannot exist. True the 
epidemic cause may exist without infection ; hut the epidemic 
cause is one thing and an epidemic is quite another thing, 
and cannot exist unless this epidemic cause, has a contagious 
infection, and this infection must find a congenial soil, be- 
fore the disease, much less an epidemic of this disease, can 
be produced. The next proposition is: "There is not a 
solitary instance on record of diphtheria ever having been 
carried from one town to another." 

Perhaps not, as there is but very little recorded, as to the 
mode of its propagation. But if this assertion is a fact, 
I shall at least "record'' one, and thus take away its force 
for the future. But even this is* unnecessary as in 1878-9 
this disease became epidemic in the province of Kadakoff, 
Russia, and the people changed from town to town, to es 
cape the disease, but the pestilential contagion clung to them ; 
they finally commenced to fly from the province, the Russian 
government became alarmed for the safety of the nation, 
and sent an army to quarantine the flying population, and 
thus limit if possible, the disease to this one province. 

In 1879, in the eleventh ward in San Francisco, there were 
quite a number of cases ; a lady had lost her only child, and 
for rest, crossed the bay and came to San Leandro. In three 
days after her arrival, the disease appeared in the family 
where she was stoping ; and in the following three months, 
there were over three hundred cases in this town and valley, 
and no other originating cause could be found. 

The simple facts are that the essential blastema of this 
may, from contact, attach itself to any dry substance and 
remain there for an indefinite time, coming in contact ao-ain 

7 o ~ 

with the proper atmosphere these fauna may be liberated, 
again float in the surrounding atmosphere, and coming in 
contact with an abrasion on a mucous surface, develope at 
once the disease. 

For this reason, school trustees, wisely interdict children 
attending school, where a member of the family, which they 



IS DIPHTHER1TIS CONTAGIOUS? 25 

represent, is known to be afflicted with the disease. The 
basis i>f this interdiction is found alone in the fact, that it 
has been carried from the family circle to the school-room, 
and from the school-room back to the family circle, and if 
it in ay and has been carried from the family to the school- 
room and vice versa, could it not just as easily be carried 
from one town to another, as from one house to another. 

That it may have been epidemic in certain cities, and no 
embargo on travel, yet not communicated to other cities is 
highly probable. Parties traveling even from one town to an- 
other, do not usually board and lodge in houses thus afflicted ; 
but generally in clean, well ventilated, well disinfected hotels, 
quite removed from all infectious contagions, and hence, 
are not at all likeh to become a circulating medium for a 
disease, with which they have not been placed in contact. 
Let them remain over night in the sick-room, then without 
change of clothes, or disinfecting come in contact with a 
child with its throat in a proper condition to take the dis- 
ease, let the atmosphere be in a proper condition to favor 
the liberation of these diphtheritic fauna, from their rela- 
tion, and then see! you will find that in ninety five per cent 
of cases, the disease will thus be carried not only from one in- 
dividual to another, but from one town to another, and there 
from one family to another. If this sentiment, based as it 
is on the most superficial observation, had no other pernici- 
ous tendency, it is pre-eminently calculated to lessen that 
cautious watchfulness which is so essential to the protection 
of human life in case of epidemic disease. But then, when it 
is found to be uusustained by the facts in the case, it became 
not only pernicious in tendency, but false pe?' se, and as such 
may be productive of untold mischief. 

We have thus shown that diphtheritis is infectious and 
contagious, we have found the modes of its propagation, 
and would in conclusions suggest, that whenever a solitary 
case is found to exist, every effort should be made to find 
and remove its productive cause cesspools, sewers, vaults, 
in fact all stagnant pools of water should at once be cleansed 



26 PATHOLOGICAL ANATOMY. 

and disinfected, clothing washed, and the habitation ventila- 
ted and purified. The sick chamber should be without pa- 
per on the walls or carpet on the floor, all intercourse with 
the family, should, as far as possible, be avoided. A ten- 
der mother should even refrain from kissing her child, for 
in so doing, she not only jeopardizes her own life, but the 
life of other members of her family. The trusted physician 
and faithful nurse, alone should enter the room, and never 
leave without thoroughly disinfecting themselves and their 
clothing, and prophylactic remedies should at once be occa- 
sionally administered to all the family. Willi these precau- 
tions faithfully carried out, I am fully satisfied that an ep- 
idemic of this disease need not occur. And thus a laroe 
amount of suffering could be prevented, and many lives be 
saved. 

CHAPTER, IV. 
PATHOLOGICAL ANATOMY. 

If our previous position is correct, that this is a consti- 
tutional disease, and it is ; then our anatomical investigations 
must reveal morbid changes consequent, in nearly every 
organ and tissue of the body, not necessarily in every case, 
nor all in one particular case ; the organs and tissue affected 
may vary according to the violence of the attack, or the id- 
osyncrasies of the patient. 

The most important pathological, anatomical structure 
attracting the attention of the investigator is. 

The false membrane. This, though generally found 
in the fauces, may sometimes be found on any mucous sur- 
face in the body. The lungs, bronchi, oesophagus, stom- 
ache, duodenum, jejunum, ascending, transverse, or decend- 
ing colon, the rectum, vagina, nose and eyes. 

The existance of this membrane constitutes one of the 
most important diagnostic parts of this disease. It is in fact 
the most prominent as well as the most common characterist- 
ic. It is a tough, firm, elastic, substance ; sometimes quite dry 



PATHOLOGICAL ANATOMY, 27 

and comparatively brittle, of a greyish white color, though 
sometimes it may become yellowish or even a greyish brown. 
It expands by the application of acetic acid, and will become 
almost transparant. It will enlarge and apparently multi- 
ply in a strong solution of chloride of PotassL It is insol- 
uble in water, but may be dissolved by a strong solution of 
the caustic alkalies, it yields neither gelatine nor albumen. 
It may vary in appearance from a thin semi-transparent pel- 
licle to a skin as thick as thin sole-leather. 

In a mild case, on a separation of the membrane from ad- 
jacent tissue, the mucous membrane will be found to be 
smooth, and considerably paler, than when in its normal 
condition ; but if the attack has been severe, more or less 
ulceration will be found to exist. 

in an axamination of the membrane from 247 patients, 
It was found to consist largely of tibrine, the result of epithe- 
lial changes in the location directly affected, and comes, or, 
is exuded from the blood serum ; it contains degenerated 
epithelium, blood, mucous and bacteria. The latter was found 
present in every case ; but every case was selected, because 
of its being of the malignant type. Other observers, Soef- 
fler, Klebs, Koch &c, have not apparently found them so 
uniformly present. Hence, So effler reports finding the bac- 
teria present in a smaller percentage of cases, and finding 
them present once in twenty cases of healthy mucous mem- 
brane. This difference may arise from the variation in the 
character of the membrane examined, the difference in the 
power of the instrument used for their detection, &c, &c, 
I have used uniformly a binocular instrument of 500 diam- 
eters, and selected my membrane invariably from a malignant 
type of the disease, after it had made fifty hours progress. I 
have however, found them in membrane as soon as it was 
sufficiently formed to be detached, and of the non-malignant 
type. 

My experiments and examinations were not conducted as 
a mere matter of idle curiosity, but simply with a specific 
end in view, and that end has always been prominent, all 



28 PATHOLOGICAL ANATOMY. 

else subordinate ; and persued only so far as they were im- 
portant to that end, i. e., the cure of the disease. Many of 
these speculative points, would be intensely interesting to 
the investigator, and instructive to the intelligent, healthy 
reader. But the busy practitioner has no time for this. 
Hundreds are annually dying all around him from this dis- 
ease, his own loved and perhaps lost, admonish him to make 
all reasonable haste to find if possible a cure, a prophylactic 
to prevent dissemination, and cure when disseminated. 

The following appears to me to be the method of its for- 
mation. The irritation created by the lodgement of the 
diphtheritic blastema, on the inflamed and already irritated 
fauces, as from colds, &c; the epithelium becomes swollen, 
clouded, indentated, and finally dissolves into a species of 
net-work; and later becomes the recipient of newly formed 
cells ; infiltration of the mucous membrane takes place, pus 
cells and granules form ; the cellular tissue become dotted 
with granules. The decomposition of cellular tissue results in 
a fine granular deposit, and developes a species of membranic 
uecrosis, hence, the sensibility of the sentient nerves becomes 
blunted, to such an extent that but little pain is complained 
of in the throat, till after the disease has made considerable 
progress; and this lack of pain, has mislead more physicians 
who were not familiar with the etiological facts and the path- 
ology of the disease, than all else combined. Virchow, re- 
gards this as one of the most important diagnostic elements 
in the severe forms of diphtheritis. 

From the works of those regarded as authority in this dis- 
ease, the clinical difference generally supposed to exist be- 
tween the membrane of croup and diphtheritis, does not 
appear to be well born out by microscopic examination ; 
and this fact, has lead to the hasty conclusion that there 
really is no difference. 

In 1870 Weigert declared that the membrane in diphtheritis 
"arises from parts deeper than the epithelial layer, and 
that a division into croup, pseudo-croup and diphtheria may 
be made," and he then gave the method for this differentia- 



PATHOLOGICAL ANATOMY. 29 

tion, and adds, "Thus when there are but few leucocyte*, 
the deposit is a net-work of fibrillse, it is croup; when there 
are numerous leucocytes, and the masses are more solid it is 
pseudocroup or pseudo-diphtheria. When the tissue is hard 
like coagulated fibrin, when it does not occur on the surface, 
but is deeply embedded in the mucous membrane, the pro- 
cess is diphtheria." To me, it is passingly strange, how even 
that the most casual observer could have failed to observe 
this marked difference, in the membrane in these two dis- 
eases. In fact the difference is so marked, that it requires 
but little practice to recognize this difference with the naked 
eye, without the aid of a microscope at all. 

The membrane in croup, is always characterized by these 
fibrillar manifestations. The membrane in diphtheritis is not ; 
but is characterized bv fibrine, epithelium, blood, in a state 
of degeneration, mucous, and bacteria ; all of which, may 
be easily seen with a microscope, but the fibers running 
length-ways through the membrane of croup, gives it a pe- 
culiarly redish color. While the membrane in diphtheritis, 
has always a yellowish, greyish white, or, greyish brown, 
appearance : and this color is so marked, that the most ordi- 
nary practitioner need never be mislead, in his prompt di- 
agnosis. 

But in order to fully anticipate the lesions which may oc- 
cur, as complications in this disease, which may even jeop- 
ardize the life of the patient, after the local manifestation 
of diphtheritis may have disappeared. 

We shall now point out the most prominant of these. 
/. The Lungs. — Occasionally, these organs may not be 
affected; but from their proximity to the seat of the lesion, 
and their immediate connection by air passages, with the 
mouth and nose; the air passing through these to the lungs, 
must become loaded with foul exhalations from this disease, 
if not putrid surface ; and is almost certain to induce more 
than irritation of these organs. Hence, we often find in- 
flammation, congestion, oedema, broncho-pneumonia, em- 
physema, ecchymosis, &c, as attendant complications of this 



30 PATHOLOGICAL ANATOMY. 

disease, and any one of these complications may destroy life 
after the local, diphtheritic lesion may have entirely disap- 
peared. So the successful practitioner must ever be on the 
alert, to detect the inception of any one of these possible 
lung complications, and check its progress promptly, or 
its results are almost certain to be fatal, as the patient is 
already in a state of physical depiction, and not prepared to 
sustain the aggression of these new complications. 

II. The Spleen. — The peculiar province of this organ is 
to raise white blood corpuscles to red blood corpusles ; 
and the red blood corpuscles being rapidly destroyed by the 
bacteria in this circulating medium in this disease ; to thus 
supply the necessary demand of the system, an increased 
amount of labor is entailed on this organ and thus when it 
has partaken largely of the general depletion of the system, 
this is almost morallv certain to involve this organ in fresh 
complications. 

This we often find as an attendant on diphtheritis; and an 
unpleasant complication, is hypertrophy of the spleen. I have 
found this complication much more common in patients who 
have previously suffered from intermittent fever, and have 
been freely treated with quinine ; and in a case of this kind 
this complication should always be anticipated. 

We may on the other hand, have simple congestion of this 
organ, or it may loose its vitality and become perfectly fri- 
able, leave us with leucothema as an attendant complication 
which connot be cured till the normal vitality of this organ 
is restored. Or, while the organ itself may retain quite a 
large amount of vitality. Simple infraction may occur, and 
thus its function may be imperfectly performed, while with 
the exception of this infraction the organ may be perfectly 
normal. 

III. The Kidneys. — These organs, in this disease, may 
remain normal, and their functions not be disturbed ; but 
as a rule this is not the case. They become congested, in- 
flamed, the seat of parenchymatous, or interstital nephritis. 
To such an extent is this sometimes the case, that their func- 



PATHOLOGICAL ANATOMY. 31 

tions are partially distroyed, or entirely so, for the time 
being at least. 

IV. The Lymphatics. — Are very generally involved, 
they are very frequently inflamed and swollen. They often 
become hard and unyielding; sometimes they are soft, cede- 
matous, and their functions materially disturbed. 

V. The Intestinal Canal. — If, Rajewsky's conclusions 
are correct he claims to have clearly proven that inflamma- 
tion of the intestinal tract must be succeeded by the presence 
of bacteria, before diphtheritic membrane can form in the 
alimentary canal, and even Virchovv concludes that diphthe- 
ria of the intestinal canal is characterized by fibrous deposits 
on the surface and in the tissue of the intestines ; with a 
subsequent, granular, degeneration of the tissue. 

I am lead to conclude, that the observations of both these 
investigators are not only correct, with reference to the ali- 
mentary canal, but their conditions, are essential to the ex- 
istence of the diphtheritic membrane in any other part of 
the body. These conditions may be thus summarized. In- 
flammation, degeneration, perverted granulation, as essen- 
tial conditions for membraneous formation. 

But the intestinal functions may be materially disturbed 
without diphtheritic membrane being deposited on their sur- 
face. As the red-corpuscles are distroyed, the blood looses 
its sanguinous elements, and the aqueous element is multi- 
plied; this is likely to become infiltrated into the alimentary 
canal and produce free aqueous discharges from the bowels, 
or, in milder cases, the febrile reaction may run high, and 
thus cause a rapid comsumption of the aqueous secretion of 
the bod} 7 and produce severe constipation. In either of these 
cases, the intestinal canal on post mortem examination pre- 
sents the usual appearance characteristic of those conditions. 
While in other cases no alteration is found in their appear- 
ance unless the actual seat of disease is manifest there. 

VI. The Brain. — It may be premised that some- cases 
may be found in which there are no alterations in the organs 
of the cranial cavity ; but from the proximity of these organs 



32 PATHOLOGICAL ANATOMY. 

to the sent of the local manifestation of this disease, and 
the consequent irritation attending this local lesion, we mav 
as a rule, look for corresponding cerebral trouble. 

If the fever runs high, we find all stages of delirium at- 
tending the disease, from low muttering delirium up to the 
wildest and most frantic hallucination. Sometimes even 
amounting to actual frenzy, the product of congestion, en- 
gorgement or inflammation of the meninges, or of the neu- 
rine substance of the brain itself. 

In cases where the septic condition has been very marked, 
lymph and even pus, have been found in the arachnoid mem- 
brane, and embolus is frequently found in the vessels ; and 
if death occurs from asphyxia, a venous engorgement of 
the membranes of nearly, if not quite all the cerebral sub- 
stance will be found to exist, showing serious cerebral com- 
plications. 

VII. The Muscles. ^— These generally present the incip- 
ient symptoms of the disease; and consequently are apt to 
be among the first to undergo pathological changes. Ec- 
chymosis, or eff'ussion of blood beneath (he skin, developing 
a red spot, from the size of a pea, to that of a silver dollar 
frequently takes place, and has sometimes been mistaken 
for "spotted fever' '. Erroneously so called. 

Myosites, or, inflammation of the muscles, not unfrequent- 
ly takes place, and may be mistaken for rheumatism, which 
I have never found present in this disease; and which I 
apprehend is not likely to occur, as diphtheritis can only 
flourish in an alkaline, and not an acid diathesis; the latter 
of which is essential to the existance of rheumatism. 

Again, there may be grey degeneration, or atrophy. While 
muscular paralysis is not only a severe, but often an obsti- 
nate attendant, and a long continued sequela of this disease. 

VIII. The Heart. — Some investigators claim that they 
often found this organ in the worst cases of this disease per- 
fectly healthy, and its membranes and functions scarcely 
disturbed. This I conceive to be an absolute impossibility. 



PATHOLOGICAL ANATOMY. 33 

This may occur in exceedingly mild cases, but I am satisfied 
it is never the fact in malignant case-. 

There is often present inflammation of its cellular tissue, 
parenchyma, which may, and frequently docs develope se- 
vere carditis, endocarditis, &c, <fcc. This may become so 
severe that engorgement of the organ and rupture of minor, 
or important vessels may follow, and death suddenly take 
place, from cause unknown to friends and obscure to the at- 
tendant physician himself. I have found four cases where 
death was produced in this way; and I think many more 
could have been found, if the consent to make an autopsy 
could have been obtained. 

The endo-carditis affects more frrquently the mitral than 
the tricuspid, or pulmonary valve. 

Perforation of the septum of th i right auricle has fre- 
quently been found ; and even of the aorta occasionally. 

Fatty degeneration is a frequent aceompanyment, and 
thrombi can nearly always be found. 

IX. The Stomach. — This organ is both directly and in- 
directly affected by this morbid process, and is consequent- 
ly invariably affected by it. In fact it generally sympathizes 
with the system and makes a prompt attempt to expell the 
morbid material by free emesis ; failing in this, it sinks be- 
neath the violence of the attack, suspend^ its function and 
rejects,- or refuses to accept the necissary pabulum to sus- 
tain the system at large. It n >t uufrequently becomes the 
seat of membraneous deposits, which adhere to its surface, 
obstruct its power of digestion and derange* its functions. 

Occasionally deep seated ulceration, beneath these mem- 
braneous deposits take place; sometimes even forming 
severe perforations of the entire membrane of the organ. 
While a sloughing off , of the necessary mucous of its lining, 
is not an infrequent consequence of the irritative inflamma-- 
tory process, set up by continuous accumulations of the mor- 
bid material from the inflamed exudation of the fauces. 

Thus, it will be found by careful analysis that there is 



34 DIAGNOSIS OF DIPHTHERITIS. 

scarcely a substance, organ or tissue in the whole human 
economy, but what, is invaded and becomes seriously derang- 
ed by this morbid process. This fact alone, shows the utter 
falacy of depending on domestic treatment ; or on a physician 
concluding his work is done. Even when local lesion has 
entirely disappeared. A careful inspection of all the organs, 
and finding normal function fully restored, alone can justify 
the physician dismissing his patient. 

CHAPTER, V. 
DIAGNOSIS OF DIPHTHERITIS. 

It must be borne in mind that diphtheritic, is a contagious 
febrile complaint, in which the throat affection, is secondary 
to a diseased condition of the blood; and as such, the consti- 
tutional disturbance may be manifested from twelve hours 
to a week before any lesion of the fauces can be detected. 
If this fact was borne in mind, and a judicious diagnosis 
made in time, many cases might be materially modified, 
others wholly aborted, and a large amount of life and suf- 
fering saved or prevented. 

A child will generally complain of feeling tired, wishing 
to lie down, pain in the back, limbs, or back of the head, 
headache, loss of appetite, vomiting, dilated pupils appear, 
accellerated pulse toward evening, fever at night. Some 
times for three nights ; the throat in the mean time will be 
found to be red and inflamed, the breath offensive, and 
the appetite impaired. Generally on the morning of the 
third day by careful examination small white pimples ma}* 
be seen just on or above the tonsils, between them and the 
soft palate. 

At the season when diphtheritis is likely to appear, or when 
it exists, in any part of a community, every child with an or- 
dinary cold, beginning to manifest any of these symptoms, 
should be carefully watched and promptly attended to; 
hygienic regulations at once inaugurated, and proper prophy- 
lactic remedies employed. If it is true, that an "ounce of 
prevention is worth a pound of cure;" here is one of the 



DIAGNOSIS OF DIPHTHERITIS. 35 

most important fields in which to demonstrate the truthful- 
ness of i he maxim, and in the end, reap its full benefits. 
Parents recognizing any of these symptoms should not de- 
lay one moment ; and if not prepared to commence prophy- 
lactic measures themselves, should send at once for a relia- 
ble physician, so that he may have all the advantage \vhieh 
an early call can secure. 

After the disease is once developed there is, or need be 
no difficulty in diagnosis. To the experienced physician the 
peculiar fcetor, attending even its early development, will un- 
mistakably point out the disease. The small pimples first 
seen on, or, above the tonsils, will have coalesced, and now 
form a continuous membrane, which rapidly enlarges, cov- 
ering the tonsii, the arch of the mouth, the palate, it may, 
or, may not be on both sides of the mouth, it may or may 
not extend back to the mires posteriores. it may, or, may 
not pass to the naies, obstruct the breathing, affect the ar- 
ticulation, and render deglutition difficult if not almost im- 
possible. 

This membrane if removed, is quickly renewed. The sur- 
rounding tissue looks a bright red, gradually changing in 
malignant cases to a dark purple, if infiltration occurs below 
the epithelium, in the connective tissue, it generally com- 
presses the intervening blood vessels and gangrene and death 
as a general thing are the results. Since it was first publish- 
ed in 1862, that the in< option of diphtheritis could be found 
in small white blisters at, or near, the base of the tongue. 
I have carefully examined 4(52 cases, and never found these 
blisters in but two cases, arid these not of the character des- 
ignated, and careful examination of their fluid contents re- 
vealed no microcosms in them. Hence, 1 conclude this phe- 
nomenon rarely exists, and is of no diagnostic value when 
found ; as the fomities which constitute the diphtheritic blas- 
temia, being inhaled in the air, do not form a lodgement on 
the tongue, but on the organs more contiguous to the respir- 
atory tract. Hence cold having first existed the nares are 
partially obstructed and the patient breaths through the 



36 DIAGNOSIS OF DIPHTHEKIT1S. 

mouth, (as nol more than half the human family know how 
to breath any way,) the air thus inhaled eoines in immediate 
contact with the larger prominancies which obstruct its de- 
cent into the bronchi, i % e., the tonsils, palate, &c, &e, and 
form a lodgement there, and there commence their distinc- 
tive work of disintegration, and consequently here form their 
first manifestation, and diagnostic indication. 

In a record of 974 cases, I have invariably found the fever 
of an intermittent type ; which in the inception of the dis- 
ease generally commences between six and ten o'clock in the 
evening, and declines from one to six o'clock in the morning. 
Hence, high, continuous fever, at, or near, the commence- 
ment of the attack, should be regarded as of doubtful im- 
port, as a diagnostic indication. In fact fever is not always 
a prominant symptom; so in diagnosis, but little importance 
can be attached to it. 

This internal irritation soon developes swelling of the neck, 
especially just below the angle of the jaw. Granules will 
soon be found existing there on one or both sides of the neck 
as the case may be, and are important diagnostic elements, 
especially when the base of the irritation extends to the usual 
fossa and so far concealed back of the soft palate that it can 
not conveniently be examined. 

The eyes have a peculiar liquid, glossy expression ; and I 
have always found the pupils dilated in the early stages of 
the disease; and the dilatation such as to give the eye the 
expression refered to and will not easily be mistaken by the 
observant physician. 

Diphtheritic membrane forming in the conjunctiva, vagina, 
or in abrasions on any other part of the body, could only be 
confounded with a single purulent coating, which mav some 
times appear ; when ocular facilities alone are at hand, but 
even then, the difference in the exudation is such, that con- 
fusion between the two processes is not likely to occur. 

To the scientific practitioner, if an analysis of the urine 
reveals the presence of albuminuria in the commencement of 
the disease, he may depend on diphtheritis being present; 



DIAGNOSIS OF ■DIPHTHERITIS. 37 

if it appears later on with the other symptoms present be, 
in all probabilities will have a case of scarlet fever. 

The paralysis which sometimes accompanies diphtheritis, 
but more generally follows, can easily be designated, if the 
case has been correctly diagnosed in the begining, and care- 
fully watched from the commencement. The special char- 
acteristic of diphtheritic paralysis, is, that it generally starts 
from the pharynx, its course is exceedingly irregular, it is 
mostly peripheral in character, and generally motor, though 
sometimes sensory, and occasionally both. 

I have never found but one case of diphtheritic paralysis, 
and am more disposed to regard it as a sequel of improper 
medication, than of diphtheritic poison. My reason for this 
conclusion is that in the history of all cases of diphtheritic 
paralysis, which I have been able to obtain, there has been 
a free and persistant use of the "bromides ," or, "chlorides," 
and T have never found a single case of diphtheritic paralysis 
where these had not been freely exhibited 

DIFFERENTIAL DIAGNOSIS. 

Diphtheria may be confounded with croup, tonsilitis, 
laryngitis , confluent herpes of the throat , and, scarlet fever . 

1st. In diphtheritis the localinflammation begins in the 
pharynx instead of the trachea, or in tissue immediatly ad- 
jacent to it. 

In croup the seat of the inflammation is in the tracing, 
or the membranes surrounding it. 

2nd. In diphtheritis the inflammation may spread to the 
trachea, oesophagus, nares, fauces, and involve the whole 
upper portion of the respiratory organs. Croup seldomly 
spreads beyond the organs which are the immediate seat of 
the disease. 

3rd. Diphtheritis, attacks adults, as well as children. 
Croup is confined to children only ; and to children generally 
under five years of age. 

4th. Diphtheritis, is attended with extreme prostratior 
and in older patients is much more likely to prove fatal bj 



38 DIAGNOSIS OF DIPHTHERITIS. 

asthenia. Croup is more likely to prove fatal among the 
younger children by asphyxia, through obstruction of the 
larynx. 

Diphtheritis is distinguished by a false membrane which 
has been fully described in our pathology. In uncomplicated 
croup, no membrane exists, and no membraneous exudation 
occurs, and none of the bacteria. Oidium Albicans are found 
to exist. 

5th. Tonsilitis Acute. It is sometimes very difficult to 
differentiate Diphtheritis, from Acute Tonsilitis, in the early 
stages of the disease. If the attack however is tonsilitis, 
the inflammation either promptly sudsides, or suppuration 
takes place, and thus all doubt as to its nature is speedily 
removed ; while diphtheritic inflammation promptly spreads 
to all the posterior organs of the mouth. 

In tonsilitis no membrane forms. In diphtheritis the 
membrane begins to exude shortly after the irritation is set 
up. 

6th. Catanhal Laryngitis. When of a severe type, is 
quite difficult to differentiate from diphtheritis. The history 
of the case, the appearance of the eyes, the intermittent 
character of the fever, will all assist in forming a positive 
conclusion, even in the early stages of the disease. 

In Laryngitis, the fever is continuous. In Diphtheritis 
it is intermittent. 

In Laryngitis, the larynx is the seat of the inflammatory 
process, which is of a bright pink color, and it seidomly 
spreads to the arch of the mouth, or involves the nares. In 
Diphtheritis, the seat of the inflammatory process is the 
pharynx, or its adjacent tissue, and is of a deep scarlet, or, 
bluish purple color, extends to the arch of the mouth involv- 
ing the palate and nares. Catarrhal Laiwngitis, nearly al- 
ways ends in recovery, and leave no severe sequelae behind. 
Diphtheritis, frequently is fatal, and when recovery does 
take place, severe, and after long protracted sequelae follow 
in its wake. 

7th. Confluent Herpes of the Throat. There are four va- 



DIAGNOSIS OF DIPHTHKRITIS. 39 

rieties of this species of disease, the variety however affect- 
ing the throat, is generally the product of catarrhal irritation. 
[t commences with a sense of heat, succeeded by inflamma- 
tory action, on this inflamed surface arises round, grouped, 
vesicles; which form in patches, and are surrounded by a 
red areolar. While if it appears on the throat, it is also 
manifest on the lips, as in case of patients suffering from 
pneumonia, intermittent fever, ephemeria, or epidemic cere- 
brospinal meningitis. 

This will enable even the non-professional to distinguish 
this disease from diphtheritis. As in Herpes, the patient 
complains first, of heat, in the throat. Diphtheritis is pre- 
ceeded by other symptoms, and the throat is seldomly com- 
plained of till the disease has made considerable progress. 

In Herpes, the vesicles contain a fluid, at first clear, then 
milky and soon disappears. 

In Diphtheritis, the pimple, simply forms a channel for 
the egress of the exudated lymph, which is forced out of 
the epithelium, and rapidly spreads forming the false mem- 
brane. 

Herpes, is accompanied by a rapid rise in the temperature, 
accompanied by as rapid a fall. 

In Diphtheritis the temperature seldom rises before 
evening and does not decline till towards morning. 

The pain in Herpes, is of a burning smarting character, 
in Diphtheritis, when present, it is of a dead, aching con- 
strictive character, and is seldomly complained of, except 
from the act of deglutition. 

8th. Scarlet Fever. Of this disease there are three varie- 
ties, or ihree grades of the one variety; and Scarlet Fevei 
anginosa, or maligna is the only grade of this disease with 
which diphtheritis is at all likely to be confounded, and onh 
then, when the eruption is slow, or fails to appear, nearly, 
or altogether. 

In this disease, there is at once extreme depression of all 
the vital force of the body. In diphtheritis, this depres- 



40 DIAGNOSIS OF DIPHTHERITIS. 

sion is not near so prompt or marked, comes on much more 
gradually, but in the end may be equal!} 7 severe. 

In Scarlet Fever, there is great cerebral disturbance with 
low delirium. 

In Diphtheritis, the cerebral disturbance is not so mark- 
ed, if it occurs at all ; and when it doe> occur, it generally 
partakes more of the character of some peculiar hallucina- 
tion, or morbid fancy, and is seldomly, if ever, in the low 
type which characterizes scarlet fever. 

In Scarlet Fever, the larynx is almost never attacked, 
and hematuria is common. 

In Diphtheritis, the larynx is always attacked and hema- 
turia very seldom occurs. In fact in many years of con- 
stant practice, and of making this disease a specialty. I 
have never met with this complication of this disease but 
once, and then it was a sequela, rather than an accompany- 
ment. 

In Scarlet fever, if the rash appears, it has a peculiar 
punctured appearance, there is less anorexia and more pros- 
tration, the throat has a less brilliant red, and membrane 
seldomly appears, and when it does appear, is more of a 
simple, plastic, exudation of mucous, and is easily detached. 

The rash is not a common attendant in diphtheritis, and 
is of quite a different character, from that of scarlet fever. 
It generally appears in patches, and at different periods ; 
appears suddenly, and is of a uniform erythematous charac- 
ter. Though I have had one case, where the pustular for- 
mation, presented most of the characteristic of confluent 
small-pox ; and it was extremely difficult to persuade the 
attendants to the contrary ; and this eruption continued ten 
days. It commenced on the third day of the disease, and 
continued till the thirteenth day, and apart from the areola 
in small-pox was the nearest like it of anything 1 have ever 
met. The patient was a Portugese, 28 years of age, black 
hair and eyes, dark skin and of an intensely billious temper- 
ament. The case was of a malignant type, and the system 
loaded with morbid material. 

I perhaps, should have named another disease which may 



DIAGNOSIS OF DIPHTHERITIS. 41 

appear at certain times, in certain localities, with which 
diphtheritis may be confounded, and an incorrect diagnosis 
in this possible case, would he morally certain to be produc- 
tive of serious, if not fatal results ; and that is — 

9th, and lastly. Putrid Sore Throat, in this disease, there 
is for sometime but little difficulty in swallowing. In (iiph- 
theritis, from a partial paralysis of the muscles controlling 
deglutition, there is more or less difficulty in swallowing from 
the first. This disease of the throat manifests itself by can- 
kers, sores and ulcers, more or less malignant, but which 
appear first on the back part of the throat. In diphtheritis, 
these never appear at first, and never on the back part of 
the throat. 

True, in the progress of the disease, they may extend there, 
but this is not the point of their first appearance. 

In putrid sore throat, the ulcers are corroding, and change 
from an ash color to a peculiar livid hue, and then become 
black, gangrenous, and putrid, the tissue literally rots and 
falls away. 

In diphtheritis, these phenomena never occur. The char- 
acteristics in common, with the two diseases, are, more or 
less fever, though in putrid sore throat, the fever is seldom 
of the intermittent type, chilly sensations, vomiting, purg- 
ing, hoarseness, <fce, &c. But if the above differential points 
are borne in mind, the one disease need never be mistaken 
for the other. 

SUGGESTION. 

Every head of the family, husband and wife, should be- 
come familiar with general diagnosis, so that even domestic 

O O 7 

remedies could be intelligently employed in cases of partic- 
ular emergency, before a physician could be called. The 
general jumbling together of diseases, wholly dissimilar, and 
consequently, promiscuous prescribing without thought, or 
intelligent consideration, which characterizes many families, 
is a disgrace to our boasted American intelligence, and should 
be a source of shame and humilation to every family capa- 



42 DIAGNOSIS OF DIPHTHEKITIS. 

I)le of feeling shame. Every practitioner, almost in the land, 
has been called, "too late," to see diphtheritic patients, 
after a family had exhausted their skill and materia mediea, 
"of castor oil, ham berg- tea, snuff and hogs lard, fat bacon, 
cabbage leaves, corn meal, flaxseed meal, roasted onions and 
coal oil," any one of which would have done more good if 
given, or applied to the prescriber, and the poor patient had 
been allowed to rest, and his vis a tergo, depended on for cure. 

This catalogue forms the family cure-alls, applied, varied 
or modified according to the dictates of caprice, fancy, or in- 
tuition, without a diagnostic precedent, a physiological cause 
or a therapeutical application, become natural depresants 
of physical force, and thus facilitate disease, and hasten 
mortality. Such families should ever bear in mind that an 
unwarrantable interference, is infinitely worse than doing 
absolutely nothing, and especially so, in this disease. 

Its. essential characteristics should be carefully studied, 
and intelligently comprehended, so that its earliest manifes- 
tations could be promptly met, and thus the disease kept in 
check, till a physician could arrive, and he get his patient 
under favorable circumstances ; instead of with vital force 
all exhausted, just waiting for the winding sheet and grave 
to close the scene ; while he is compelled to repeat those 
dreadful words, too late, too late, or if he, in his kindness 
makes the attempt to cure, and fails ; then to hear the 
families execration, and slander. 

"He didn't know anything," "I could have done better 
myself" "quack," "fraud," humbug;" with all the other 
expletives of a sympathetic, generous, public; who never 
stop to think that a physician can feel as well as themselves, 
and has rights as well as the} 7 , and that before a competent 
jury of their own peers, a verdict of manslaughter, if not 
murder mis;ht be found, and stand recorded against them, 
on the docket of any judge of competent jurisdiction, and 
if so, that just such a verdict, is recorded against their names 
and waiting to meet them in a coming day before an assem- 
bled w r orld, for "shall not the judge of all the earth do right?" 



PROGNOSIS. 43 

CHAPTER. VI. 
PROGNOSIS. 

Among the various zymotic diseases, there perhaps is none, 
in which the prognosis, should he more guarded than in diph- 
theritis. Success in previous treatment, is even a precarious 
predicate, and afalacious basis, for individual cases. I have 
treated nine hundred and seventy six cases, in the past ten 
years; and have never lost a case, when I was called before 
the disease passed the third day of its duration ; this has of 
eouise induced a firm reliance on the remedies employed: 
but from constitutional, pre-existing, taint idiosyncrasies 
and various complications, which may thwart the best devis- 
ed remedial agents, and disappoint the most sanguine expec- 
tations, I have learned to be exceedi. g cautious in my prog- 
nosis. Even afier the diphtheritic phenomena are all re- 
moved, there are so many attendant, morbid, complications, 
so many unlooked for consequences, so many protracted 
sequela may arise, which our best conducted plans ma} 7 fail 
to meet ; that for the credit of the profession, the honor of 
the physician, and the happiness of the family, our progno- 
sis had always better be guarded and cautious, as no patient 
i> out of danger till the last vistage of all remaining sequela, 
or attendant consequences are removed, and have intensely 
disappeared. 

Five years ago, I had a case of malignant diphtheritis, 
a somewhat delicate lad of fourteen years of age. The friends 
had all concluded he must die : but by close attention, coup- 
led with the best of care, on the part of the nurse, I, to the 
delight of all, self, included, succeeded in overcoming all 
morbid phenomena, and had my patient up and walking- 
round. I dismissed the case, on Thursday, and went home 
some sixty miles distant on Friday, and on my return on 
Monday following, was terriably mortified to find my dismiss- 
ed patient dead and hurried. I learned he had continued 
improving up till Friday noon, when he ate quite a hearty 
dinner of corned beef and cabbage, immediately after which 



44 PROGNOSIS. 

he complaned of feeling unwell, went to his room and laid 
down, and in twenty minutes after was a corpse. 

The meal was evidently too heavy for his weakened stom- 
ach producing a depression of attending plexus; this depres- 
sion was reflected to the cardiac nerves, and produced a 
suspension of the hearts action, and it ceased to pulsate. I 
had given every necessary caution about diet &e, hut my 
cautions were unheaded, and death was the result. But the 
blame, as much as if 1 had caused his death, all fell upon 
the physician. 

So, to consider that recovery is even probable, before the 
disease has run its course, is exceedingly unsafe ; and even 
then, reactions, unforseen circumstances may occur ; and 
recovery again be placed in doubt. 

The general course of an epidemic may have some small 
influence on our prognosis; but it must be exceedingly small 
as it is generally the mild, or convalescent cases which are 
most deceptive, and more likely to prove fatal. 

Generally speaking, the prognosis is favorable when the 
local manifestations are small, and is situated on that part 
of the fauces which has least communication with the system 
by the lymphatics. 

The extention of the disease to the larynx, the nares, or 
to find the swelling of the arch of the mouth seemingly creep- 
ing forward along the arch, in front of the palate, towards 
the teeth is an exceedingly dangerous manifestation. 

To find the membrane beginning to form in the bronchi, 
oesophagus, the corners of the eyes, mouth, vagina, or in 
wounds on any part of the body is exceedingly unfavor- 
able, as it shows a serious breaking down of blood corpuscles, 
compelling an exudation of plastic lymph through the vari- 
ous mucous membranes of the bodv indicating an intensefied 

loss of vitality. 

High fever is unfavorable, as it rapidly increases the loss 
of vital force, and augments the local inflammatory process. 
Any form of delirium is unfavorable, as it shows severe com- 
plication of either the meningies or the nervine matter of 
the brain substance. 



PROGNOSIS. 45 

A septic, or gangreneous form of diphtheritis, is exceed- 
ingly dangerous, as in addition to the destruction of red blood 
corpuscles by the bacteria, oidium albecans, pus is added to 
this circulatory fluid and destructive metamorphosis rapidly 
takes place. To such an extent is this the case, that a pa- 
tient may be left to day at three o'clock in the afternoon 
doing nicely, and everything favorable and the physician 
and friends be sanguine of a speedy and permanent recovery. 
To morrow at three o'clock we may return and find our hopes 
blasted, our expectations disappointed and our patient, if 
not dead, at least beyond the reach of remedial agents. 

A rapid, small, irregular pulse, is a very unfavorable 
indication, as it indicates a failure of cardiac force, and es- 
pecially if there is not an approximate normal relation be- 
tween the pulse and the respiration. 

The discharge of an acrid fceted secretion from the nose, 
is a grave indication, and especially so if it cannot be con- 
trolled. In fact every complication adds to the gravity of 
the disease, and renders prognosis rnoie uncertain. 

After convalesence becomes well established, the origina- 
tion or extension of paralysis to the respiratory muscles, is a 
very alarming indication. 

Croupy symptoms, arising from an extention of the mem- 
brane into the larynx, is an indication of immediate danger. 
The membrane commencing to turn I lack, or even brown 
indicates a failure of the vital powers, and points to an early 
disolution. 

Hemorrhage, from the nose, throat, bronchi, or intestines 
are all unfavorable indications, as they show the plasma of 
the blood distroyed and the aqueous elements alone re- 
maining. 

Purpura, appearing on the body, an excessive discharge 
from the nose, intense albuminuria, marked swelling of the 
cervicle glands, a rapid, or marked decline of temperature, 
nausea, or diarrhoea, at an advanced stage of the disease. 
Any one of these, points to a severe case and suggests caution 
in prognosis, two of them combined indicate eminant danger 



46 ALOPATHIC TREATMENT OF DIPHTHERITIS. 

and point to the strong presumptive probabilities of a fatal 
termination. 

Having especially pointed oat the prominent unfavorable 
indications, it will be readily seen that the non-existance of 
these are the favorable indications and lead to more hopeful 
conclusions, of a more hopeful issue in the case. 

But better submit to the oft repeated complaint of "mag- 
nifying the importance of the disease, for professional pur- 
poses," than to lower its danger; in the end, to blast un- 
founded hopes, and have justly hurled against you the 
truthful charge of professional ignorance, or what is worse, 
professional dishonesty. 

Having now canvassed the pathogney of this marked phe- 
nomenon, I shall proceed to give what is deemed the best 
treatment of all schools, and then show from the marked anat- 
omy and pathological condition of the patient, and the phy- 
siological and therapeutic action of remedies, the Rational 
treatment of this dreaded disease ; and conclude with a few 
hints on hygiene and nursing. As these pages are design- 
ed for general distribution as well as for professional hands. 

CHAPTER, VII. 
ALOPATHIC TREATMENT OF DIPHTHERITIS. 

As to what the treatment of any school of medicine may 
have been in the past, of this, or kindred diseases, or what 
it may be in the near, or distant future, are points, however, 
interesting to the inquiring practitioner, or general public, 
with which I shall have nothing, at present to do. Conse- 
quently, the treatment of this disease shall not be gathered 
from the dead past, but, the living present. From Mackinzee, 
Jacobi, Greenhow, Setzerich, Soeffler, Harrold C. Ernest <fcc, 
&c. Ernest investigators, successful practitioners, with a 
world wide reputation. And selecting these, to represent 
the treatment of the school, no complaint of injustice to the 
school can be made against me. 

By these representative men it is announced as an incon- 
trovertable axiou of truth. "That there are no specifics for 



ALOPATHIC TREATMENT OF DIPHTHEIUTIS. 47 

the treatment of Diphtheritis. But treatment must be bas- 
ed on two predicates. 

1st. General Principles. And 2nd. Local Applications. 

Prominent among general principles, arc: 

(a) Measures to maintain general health. — The tempera- 
ture of the room should be uniformly kept at from <>2to 65 
F. Sunny exposure and an open lire, should be continuous- 
ly burning, as an essential means of carrying off morbid ex- 
halations. A nutritious diet, composed of beef-tea, niii.v 
milk-punch, chicken-broth, &c, &c, is to be given regularly, 
at short intervals, and in small quantities, and it is suggested 
that this diet should be given especially in the night, and 
the reason assigned for this is, that then, "The vital powers 
are in their least resistant state." If indications of failure 
of the hearts action appear, the "patients head should be 
kept as low as possible". 

High febrile reaction is treated with sponge baths of tepid 
water. For this condition, quinine and salicylate of sodium 
are also recommended. Collapse, is met with free exhibition 
of stimulants, whiskey, brandy, wines, &c, &c. Severe vom- 
iting; is treated with subnitrate of bismuth, and diarrhoea is 
controlled with opium or some of its compounds. 

The means and methods, of meeting these peculiar indi- 
cations, are largely left to the judgement of the practitioner. 
Complete isolation of cases should be insisted on, the sick- 
room is to be kept cool, the above temperature maintained 
and plenty of fresh air admitted. The nurse is recommend- 
ed to keep the mouth closed when over the patient ; any ca- 
ressing fondling, or kissing is to be absolutely prohibited, 
Wearing cotton in the nostrils as a filter, and keeping the 
mouth closed is highly recommended. 

Treatment, should be commenced early, as there is no typ- 
ical course to the disease: hence, delays are dangerous. It 
is thought that there is small chance of over stimulation, 
and atonic never does harm, while its omission may entail 
irreparable consequences. 

It is recommended that disinfection be promptly and per- 



48 ALOPATHIC TREATMENT OF UIPHTHERITIS. 

sistantly attended to. Roll sulphur, or common brimstone 
two pounds to every 1,728 cubic feet to be fumigated, for 
rooms, and a solution of copperas, one and one half pounds 
to :i gallon of water, for every cloth that can be placed in it. 

But still better than this last, or one that is more highly 
recommended, is, a solution of corrosive sublimate, one part 
to ten thousand of water. It is recommended to use this 
freely in all privies, drains, <fec, &c, and all soiled linens are 
to be soaked in this solution. 

The National Board of Health, in Bulletin, No. 10, Sept. 
t>, 1879, give simple but efficient recommendations respect- 
ing the matter of disinfection, and the corrosive sublimate 
solution, is displaced by other agents. 

(b) Special Treatment. — These authors regard it, as of 
tirst importance, to use tho.se remedies, which have, or, ap- 
pear to have, some special effect in softing, or, dissolving 
the false membrane. 

And among these, regarded as the principal agent is steam 
inhalations. This may be used in any way most convenient ; 
the nozzle of a teakettle, inverting a funnel over a vessel, 
dropping hot bricks in water, any method of bringing the 
steam in direct contact with the membrane to be removed. 
The atomizer is of course considered best, and may be em- 
ployed in connection with therapeutical agents. Such ns hy- 
drochlorate of ammonia, chloride of potassium, muriate of 
ammonia, common salt, salicylic acid, carbolic acid, &c, &c. 

Chlorate of Potash. — Is claimed to have a very wide 
range of action, is extensively employed, and of especial 
benefit, in this disease. It is claimed that its especial thera- 
peutical value, consists in alleviating the laryngitis and stom- 
actitis, which often accompany this disease. It is claim- 
ed that it places the surrounding parts in such a position 
that the disease rarely spreads, or that the membrane rarely 
spreads to surrounding parts. It is recommended to give it 
freely, frequently, but in small doses. It is claimed that 
it is more efficacious given or used in the steam atomizer, 
and that the spray should come in contact with the mem- 



ALOPATHIO TREATMENT OF DIPHTHERITIS. 41) 

biane, for five, or ten minutes every hour. This treatment 
it is claimed, has been followed by the most happy results. 

As to the strength of the solution to be used, a saturated 
solution is recommended, or a solution so strong that the 
quantity of water will hold no more in solution ; it is claim- 
ed that this solution is rendered perfectly safe by the gen- 
eration of steam. For a child of three years of age, it is 
recommended to be weaker so that it will not get more than 
30 grains in twenty four hours. Caution is how T ever neces- 
sary in the the use of this medicine as severe cases of inflam- 
mation of the kidneys have been recorded as a result of its 
too free use. But properly used it is assured to be of great 
value ; though it is finally concluded, that it has no effect, 
in dissolving the membrane. 

It is then suggested that even steam is only found to be 
of value in those eases in which the false membrane is pure- 
ly upon the surface, and it is intimated that in all cases a 
good supply of fresh air, must be maintained, and no over- 
loading of the atmosphere should be allowed, and that the 
inhalation of steam, or even medicated vapor should be sus- 
pended as soon as it proved annoying. 

(c) Water. — To promote the secretions, and keep up 
the normal supply of aqueous elements in the system, which 
are being rapidty exhausted. The water may be given alone, 
or combined in any kind of agreeable hot drinks, from three 
to six ounces may be given every hour. 

(d) Cold Water and Cold Applications. — Ice water is 
recommended, ice-cream, or the patie«t may swallow lumps 
of ice, as any of these ma} be found to give relief. Ice-bags 
are recommended to be applied to the neck, to relieve the 
swollen condition of these glands, and easethe discomfort 
attending on the same. 

(e) Sponging. — The body with tepid water when the 
fever is high, and the surface of the body is hot, is recom- 
mended as giving great comfort to the patient. It is thought 
however, that this is contraindicated, if the feet are cold, or 
if there are any indications of enfeebled circulation. 



50 ALOPATHIC TREATMENT OF DIPHTHERITIC . 

(f) Lime Water. — Is highly recommended l>y several 
men of high standing, while others equally high, think, that 
its beneficial effects are exclusively due to its cleansing effect 
rather than its therapeutical action. The method of using 
it is hy means of a spray, sponges, or gargles and it is thought 
by its advocates, that it exerts a solvent effect on the mem- 
brane, especially when combined with glycerine ; others think 
that if it acts at all, its action is too .slow. 

(g) N'eurin. — Several writers speak very highly of this 
remedy, as being exclusively anti-fermentative ; and as Mich, 
being extremely beneficial in arresting the supposed ferment, 
taking place in the blood. Among its special advocates in 
this disease, is Winewater. But no special directions are 
given for its use, hence, the dose, indications &c, must be 
left to the individual practitioner. 

(h) Mercury. — This remedy has been employed, in this 
and almost every other disease, since the days of "heroic 
measures,^ and been extensively, and faithfully tried in this 
disease, and the conclusion of Hanold C. Ernst, finally is, 
that in this disease especially. "It has nothing to recom- 
mend it." To which I am sure, patients who have tried it, 
will say "amen and amen." 

(i) Quinine. — For many years and even at present, but 
few physicians can be found in any school, but what rely 
more, or less, on this remedy. It has been, and still is, 
used indiscriminately, independnnt of pathological conditions 
or, its pathological effect; on account of its supposed tonic 
action. In fact "quinine and whiskey," has been the sheet 
anchor of many physicians in this disease ; and still has its 
strong advocates. But the leading medical practitioners of 
the world in this school, after multitudenous trials declare 
"It is of little, or, no value ; except in cases of very high f 'ever. " 
Thus the two remedies mostly relied on, by ordinary prac- 
titioners, are now proclaimed as comparatively useless by 
the most eminent men, and advanced thinkers, and practi- 
tioners of this school. So much for the pressing advance- 
ment, of National Medication. 



ALOPATHIC TREATMENT OF DIPHTIIEKITIS. 51 

(J) Turpentine. — The oil, or, ordinary spirits used by 
inhalations every few minutes, still has its friends and ad- 
vocates. The most improved method of employing this 
agent appears ro be, to place about half an ounce in about 
a quart of water, and keep it constantly boiling in the room, 
and thus force the patient, to continuously breath ihe at- 
mosphere, pregnated with its fumes. If this remedy is of 
any therapeutical value, this is certamly the most Rational 
way of u>ing it. 

(k) Ammonia Chloride. — This remedy is supposed to be 
of some use occasionally, given in two or three grain doses 
for a child of two or three years of age, and increased of 
course in a corresponding ratio with advancing years. Others 
prefer burning a half drachm in the room and allowing the 
patient to breathe the fumes thus generated. 

(I) Astringents. — Such as alum, tanin, nitms argenta, &c, 
t£c, are now entirely discarded by those who have had the 
best facilities for observing their effects. They declare that, 
"Their use seems to retard rather than favor the exudative 
process." (The emphasis is mine.) These conclusions, em- 
inating as they do, from men who have had the largest field 
for observation, and the best facilities for inspection should 
certainly have great weight with the ordinary practitioner. 

(m) Ferri Chloride. — This remedy was introduced to 
the profession in this disease, by Gigot in France, in 1848, 
and since then has been extensively employed on the conti- 
nent and is generally thought to be beneficial, if given free- 
ly and often. From five to ten drops of the tincture is to 
be given every half hour. The Ferri certainly will increase 
the hrematin in the blood, and thus arrest distinctive meta- 
morphosis. While the effects of muriatic acid w r ill be con- 
sidered, under the head of ''Rational Treatment." 

(n) Carbolic Acid. — This remedy for a long time was 
supposed, to have some special therapeutical action in this 
disease, besides its cleansing and disinfecting properties and 
consequently has been, and by some, still is extensivelv em- 
ployed. The doctrine of these leading men now however 



52 ALOPATH1C TREATMENT OF DIPHTHER1TIS. 

is, that it has no therapeutical action beyond its cleansing 
properties, and doubt is expressed as to its even possessing 
this in this particular disease. True, it may over come the 
smell, by inducing a worse one, if it does no more. 

(o) Acidum Salicycum. — This remedy like its prediees- 
sor, has had its friends and admirers, but in advanced prac- 
tice is a thing of the past. Its only merits now appears to 
reside in its power to destroy the foul odor produced by the 
diphtheritic lesion. It is thus that the iconoclasm of facts, 
not only pulls down, but destroys the shrines at which med- 
ical ignorance, prejudice, and superstitution has bowed and 
worshiped. 

(p) Bromine. — Di. Jacobi in his work on Diphtheria, p. 
201, refers to the fact that Dr. W. H. Thomson recommends 
the use of this remedy in from six to twelve drop doses, in 
sweetened water, once in one, two, or three hours. But 
others who have used this remedy, think it unimportant and 
not deserving of the praise bestowed upon it by Dr. Thomson. 
See its use, under, Rational Treatment. 

(q) Potassa Fusa . — Twenty years ago, this was the rem- 
edy par excellence, and cauterization of the inflamed fauces, 
the practice per se 9 while its horrors, are now repugnant to 
every feeling heart. It is strange indeed, that a practice so 
barbarous, and so pregnant with only evil, could ever have 
obtained, while it is certainly stranger still, that any practi- 
tioner should yet be found who could advocate its claims, 
or continue its practice, in the present light of the medical 
science. 

Our authors mildly suggest that Potassa fusa, or chromic 
acid, or any other deliquescent salts are dangerous, because 
of the difficulty of limiting their action. See Rational Treat- 
ment. 

(r) Ozone. — Has, by some of these men been recommend- 
ed. It is recommended to inhale it, every one, or, two hours, 
from five to ten minutes at a time. Some on the other hand, 
who have used it, claim to have found no good, resulting 
from its use. 



ALOPATHIC TREATMENT OF DTPHTHERITES. 53 

Querry. (Did the-e men use a Buchanan inhaler)? to be 
consistant, they certainly should, when they employ his 
remedy. 

(s) Boracic .Acid, and Benzoate of Sodium. — -From one 
to thirtv grains of the former, and from one to eighteen of 
the latter, used as a gargle, so that a child from one to three 
years of age shall use from one to three drachms in twenty 
four hours, lias its advocates, and its opponents ; so that it 
is difficult to decide which are the most numerous. So it is 
simply left for those who wish, to experiment with these 
remedies for themselves, with the simple suggestion, always 
experiment on somebody elses children, never, your own. 

I shall now complete this list by quoting Hairold C. Ernst 
verbatum. 

(t) Sulphur. — "Inhaled, cubebs and copabia, nearly com- 
plete the list of remedies that have been employed by the 
most distinguished men, as will be seen none of them offer 
a prospect of universal success. 

Gargles, sprays, and local applications of watery -solutions 
of corrosive sublimate, in strength of from one part to three 
thousand and upwards, are the latest means employed against 
the local manifestations of this disease. The results are as 
vet too few, to enable anv estimate of their value to be made. 

Mechanical removal, of the membrane must not be prac- 
ticed. When they can be removed without the use of force 
they will come off of themselves, and this time should be 
patiently waited for. 

Swelling of the Lymphatic Glands, in diphtheria must 
be treated as of an idiopathic affection, by applications of 
cold water, ice, or ice poultices, and if absolutely necessary, 
by incision. 

Nasal diphtheria, must be combated with constant hourly 
douches of some of the remedies spoken of above. 

Laryngeal diphtheria, is occasionally benefited by the 
employment of emetics. It is when the symptoms become 
urgent in this form of the disease, that tracheotomy is resort- 
ed to, the indications being the danger of suffocation from 



54 HOMOEOPATHIC FINDINGS IN DIPHTHEK1TIS. 

stenosis of the larynx. The mortality from the operation 

incresises in proportion to the delay in its performance. 

Diphtheritic paralysis, may in many eases he treated 
simply hy rest, good food, stimulants, tonic>, as iron, qui- 
nine, and sometimes by electricity. Strychnia is recom- 
mended, hut its usefulness is very doubtful. 

Diphtheritic conjunctivitis, must be attacked at once, and 
vigorously, with ice applied locally, and boric acid, (in con- 
centrated watery solution, ) every hour. The unaffected eye 
must be carefully pretected from inoculation, and this is best 
done by covering it with lint and collodian, or with lint, 
cotton, and adhesive plaster." 

This is a synopsis of the treatment of this disease : adopt- 
ed by the best men of this school. That it should not meet 
the approbation of every minor name, is but reasonably to 
be expected. And that some obscure country practitioner, 
or some city physician, in whose august presence Galen, or 
Hippocrates ( in his own estimation ) sinks into insignificance, 
should start up and say, "you have not given my practice in 
this disease ," is simply to be expected. I have made no 
attempt to detail the practice of every small medical pre- 
tender, or would-be-great practitioner. J have simply re- 
produced the thoughts, and recorded the practice, of repre- 
sentative men of a s^reat school of medicine. I have uone 
so without note, or commentary; I have given their saving 
and doings just as I find them in their published works, and 
there I leave it, to stand, or fall on its own merits. 

CHAPTER, VIII. 
HOMCEOPATHIC FINDINGS IN DIPHTHER1TIS. 

This school of medicine numbers among its practitioners, 
some of the finest, educated minds, found in any school of 
medicine on this continent, or i:i Europe. Its literature as 
a consequence, manifests a large amount of scientific inves- 
tigation, careful analysis, and patient, careful consideration. 
The most rigid advocate of ponderous doses, can no longer 
frown infantisimal triturations out of existence : neither does 



HOMOEOPATHIC FINDINGS IN DIPHTHERITIS. 

"ityfiut.isimaWsm," constitute any essential part of Homoe- 
opathy. Their law of cure is independant of "dose." It 
simply expresses relation; quantity, is a matter for individ- 
ual judgement. The present tendency of the medical world 
is towards the minimum dose, and if Homoeopathy in order 
to first reach the goal, has gone to the extreme; it is only 
the reaction of the opposite, heroic treatment, which might 
have been expected, as an inevitable result. This practice 
has now stood the test of years ; experience, has demonstra- 
ted its practical utility, an interested, intelligent public de- 
mand its therapeutics, and demand it because satisfied with 
its results, demand it in preference to older methods, hence, 
older methods can complain as they please, while success 
attends the Homoeopathic practitioner, the public will de- 
mand his service independant of methods. 

The hugh and cry about "Infinitesimal Triturations", 
raised against Homoeopathy, as though this was all there was 
in it, is not only ungenerous, but is meanly unjust. Accord- 
ing to their law of cure, if it required a cart-load of any 
remedial agent to develope his "simila" , he is at perfect 
liberty to give it. But if the cart-load is unnecessary, and 
the thirtieth, or five hundreth, or five thousandth part of a 
grain will cure the disease, it is certainly more humane, 
more in keeping with christian kindness and common sense, 
to give the smallest amount that will doits work, and allow 
the cart-load to pass along. 

The writer is not an Homceopathist, in theory, or in prac- 
tice ; even though a licentiate of its school, and familiar with 
its therapeutics. Neither would he be a narrow minded big- 
got, or claim that the medical wisdom of the world was alone 
found in the school he represents. When medical men be- 
comes so lenient that merit, and not, schools become the cri- 
teria!) of judgement, it will be an happy day for the true, 
medical world. 

I shall use, E. Harris Ruddock, as the representative of 
this school in Europe, and Constantine Herring as the repre- 
sentative American author of the same school, on this con- 



57 HOMCEOPATHIC FINDINGS IN UIPHTHERITIS. 

tinent, using Burk, Gcurnsey, Small, &c, &c, whenever they 
may serve my purpose. 

Ruddock, defines Diphtheria as, "a specific epidemic dis- 
ease, in which some morbid material has been received into 
the blood, and in which there is exudation of lymph on the 
lining membrane of the mouth, fauces, and upper part of 
the air-passages, or, occasionally on an abraded portion of 
the skin, attended with general prostration, and sometimes 
remarkable nervous phenomena. 

As just described, it is a blood disease, manifesting local 
destructive symptoms. It would be incorrect in theory 
therefore, and might lead to grave errors in treatment, if 
the constitutional disturbances were regarded as the effects 
of physical changes about the throat, and so concentrating 
the attention on the tangible mischief, rather than attemp- 
ting to cope with the whole systemic depression. 

SYMPTOMS, 

Diphtheria is divisible into two classes, simple, and malig- 
nant. In the simple variety, happily the most common ; the 
symptoms are at first so mild as to excite little complaint 
beyond slight difficulty in swallowing, or pain in the throat, 
burning skin, pains in the limbs, &c, and is readily cured 
bv one of the following remedies. 

Malignant Diphtheria, is ushered in with severe fever, 
rigors, vomiting, or purging, sudden, and great prostration, 
and restless anxious countenance, &c; pointing to some over- 
whelming disease, under which the system is laboring. The 
skin is hot, the face flushed, the throat sore, and the mucous 
membrane a bright red, the tonsils are swollen, and grey, or 
white patches of deposite appear on them, small at first, but 
gradually enlarging, so that one patch emerges into another, 
forming false membrane in the throat, rendering swallowing 
and even breathing difficult. In some cases, the false mem- 
brane has been detached, and after extreme efforts ejected, 
presenting nearly an exact mould of the throat. The exu- 
dation of diphtheria may be distinguished from a slough by 
its easily crumbling, by the facility with which it can often 



HOMOEOPATHIC FINDINGS IN DIPHTHERITIS. 58 

be detached, and by the surface thus exposed being red, but 
not ulcerated. The false membrane looks like dirty wash- 
lather ; and between it and the true membrane, an offensive 
bloody discharge exudes, imparting to the patients breath, 
most offensive odor. The glands of the neck are always 
enlarged, sometimes pain is felt in the ear, and there is gen- 
erally stiffness of the neck ; the inflammation is liable to ex- 
tend rapidly, in consequence of the continuity of the lining 
membrane of the throat with the mouth nose, wind-pipe, 
and even the air tubes of the lungs. 

If the disease progresses, the patient passes into a stupor, 
and the difficulty of swallowing, or breathing increases, till 
the false membrane is ejected or the patient dies from suf- 
focation, the exudation blocking up the air-tubes ; or more 
frequently, he sinks from exhaustion, similar to that observ- 
ed in Enteric fever ■. 

DANGEROUS SYMPTOMS. 

Increased factor of the breath, a quick, feeble, or very slow 
pulse; persistant vomiting; drowsiness and delirium ; bleed- 
ing from the nose ; extension of the disease to the lining: of 
the nose; dyspnoea; suppressed, or albuminous urine; in- 
crease of temperature. * 

DIAGNOSIS. 

Diphtheria differs from croup in several points. 1. The 
local inflammation begins in the pharynx instead of the tra- 
chea, although it may afterwards spread to the fauces, oeso- 
phagus, and respiratory tract. 2. It attacks adults as well 
as children. 3. It is attended with extreme depression of 
strength, and in adults is usually fatal by asthenia, but in 
children sometimes by asphyxia, through the obstruction 
of the larynx. 4. Lastly, Diphtheria is distinguished by a 
false membrane ; but no real membraneous exudation occurs 
in croup. 

Some have thought that diphtheria was only scarlatina 
without an eruption ; but, although there is some analogy 
between the two diseases, further investigation has shown 



59 HOMOEOPATHIC FINDINGS IN DIPHTHEKITIS. 

that they are distinct affections. In diphtheria, the fever 
is from the first, of an asthenic type, while such a condition 
is an exception in scarlatina. An attack of scarlatina con- 
fers no exemption from subsequent diphtheria, and vice 
versa. The after effects of diphtheria are of a severe nerv- 
ous character; those of scarlatina involve mischief in the 
kidneys, or the chest. 

CAUSES AND MODES OF PROPAGATION. 
Impure air, from imperfect drainage, living too near ma. 
. nure deposits, slaughter-house, or where animal substances 
are in a state of decomposition. It commonly occurs as an 
epidemic, and a solitary case may prove a focus for spread- 
ing the disease. The severity of the attack seems to depend 
as much on the health of the patient as on the character of 
the infecting source. 

SEQUELAE. 

After a short period of convalescence, a few days to one 
or two weeks, sequeke are apt to arise, usually of disordered 
innervation, varying from defective nervous power in one 
or more sets of muscles, to a more or less perfectly defined 
paralysis, of the nerves about the throat. The seat of the 
local manifestations of the disease, are especially liable to 
suffer, causing chronic difficulty of swallowing, hoarseness, 
&c. The most alarming is, loss of nervous power of the 
heart, with feeble action, or, in extreme cases, complete ces- 
sation. But recovery from the sequeke, is not infrequent, 
though it is generally tedious." 

Oonstantine Herring H. D., who is regarded not only as 
a standard authority, on this continent, in this school, but 
who is regarded as a learned, judicious thinker, and inves- 
tigator, says respecting this disease, (and he happens to be 
one of the few writers, who designates, it by its proper cog- 
nomen, Diphtheritis, not Diphtheria.) 

"This disease has been observed by medical writers of all 
nations under different names. Its history has indeed been 
traced back as far as Homer. In the sixteenth century it 



HOMOEOPATHIC EINDINGS IN DIPHTHERITIS. GO 

was epidemic in Holland, and was described by : P. Forest. 
Towards the end of that century it raged in Spain, killing a 
great number by suffocation; whence it was called garotilla. 
Since then it has been observed every where, more or less 
violent; and in this country within a few years. 

It consists of a croupous, or plastic exudation from the 
mucous membrane of the fauces, mouth, and nostrils: com- 
mencing with febrile sensations, chilliness and some difficul- 
ty in swallowing. The fauces look inflamed; of a dark ma- 
hogany color ; and soon became covered (usually after the 
first or second day) with a dirty greyish, or gray, yellow- 
ish exudation of various thickness ; commencingin spotsand 
patches, generally on the tonsils at first ; spreading over 
the soft palate and fauces into the posterior nares and cavity 
of the nose, and in some cases into the oesophagus and larynx. 
When the skinny exudation is loosened and removed by ex- 
ternal means, it shows a merely inflamed, looking, sometimes 
an excoriated, or ulcerated surface of the mucous membrane 
beneath, which is soon covered again by the same skinny 
mass. Where it loosens itself and is thrown off spontane- 
ously, it generally does not renew itself. In malignant 
cases this pseudo-membrane dissolves into an ill looking 
ichorous mass, under which the mucous membrane appears 
in decayed shreds, or, dark colored crusts, emitting a most 
offensive odor. Mostly there exists a swelling of the sub- 
maxillary and paroted glands and of the lymphatics. The 
great prostration of all the vital powers, which accompanies 
it from the first, is quite characteristic of this complaint. 

As to its cause all writers agree that it is the effect of some 
specific poison, the nature of which we know just as little as 
that of cholera, typhus or yellow fever ; and as all persons 
are not attacked by it, it requires a predisposition of the or- 
ganism to it. 

We do not know, however, in what this consists. Besides, 
the atmospheric influences upon its spreading are not clearly 
understood ; it seems, however, that it is rather more preva- 
lent in spring and summer than in winter, and more in damp 
rainy weather, than in a uniformly dry temperature. 



61 HOMOEOPATHIC FINDINGS IN DirHTHERITIS. 

Diphthertis is not contagious, like the eruptive fever, (scarla- 
tina, measles and small-pox,) there is no evidence that it was 
ever conveyed by fomities; but we can easily conceive of an 
epidemic cause, which may bring about more or less contam- 
ination of the atmosphere, thus rendering susceptable persons 
liable to contract the disease from breathing the atmosphere ; 
or it may be propagated by our immediate inoculation of a 
portion of the vitiated secretions to an absorbent surface of 
another person, provided this person offers a congenial soil 
in which the specitic cause may develope its specific effect. 
1 . Symptoms of the fauces, are soreness and redness of the 
throat. The latter symptom may be confined to the uvula, 
velum, palate, one or both tonsils ; or it may extend all over 
these fauces. The redness may be of a dusky hue; mottled, 
of a light mahogany, or pinkish color. The parts are gen- 
erally swollen ; the tonsils to such a degree as even to inter- 
fere with swallowing. Usually after the first, or second 
day we observe some small whitish gray spots on one or 
both tonsils, which either soon coalesce, or stay separated 
through the whole morbid process ; or there may be a 
uniform deposit of this whitish gray exudation over the 
entire throat. At first it is easily detached from the mucous 
membrane, but is soon replaced by a new deposit; later, 
however, it becomes thicker, more tenacious, leather-like ; 
and adheres more firmly to the subjacent tissue, leaving, if 
it be detached, a bleeding surface behind it. On, or about 
the sixth day it usually dislodges itself spontaneously, and 
may then hang down in shreds and strings into the pharynx, 
or from the posterior nares down into the fauces; aftei 
which no new formation takes place. In malignant cases 
this pseudo-membrane disolves, as stated above, into a bad 
looking ichorous mass, under which the mucous membrane 
appears in decayed shreds, or dark colored crusts, and it is 
not unfrequent that whole parts of the soft palate become 
thoroughly destroyed. As regards the nature of this mem- 
brane, it is believed to be more of an albuminous, while that 
of croup is more of a fibrinous character. 



HOMOEOPATHIC FINDINGS IN DIPHTHERITIS. 62 

Diphtheritic membranes may be found al&o in other lo- 
calities, as the vagina; or oncutaneus surfaces, when wound- 
ed, ulcerated, or abraded. 

2. Symptoms which accompany this affection of the throat 
are; difficulty in swallowing, especially cold drinks ; this 
symptom, however, may be altogether wanting, even in very 
severe cases. 

Difficulty in breathing, especially when the tonsils are 
much swollen, or when the nose is filled with exudation and 
discharge. 

A peculiar odor of the breath, which is more easily smelled 
than described; in malignant cases it becomes almost un- 
bearable, scenting the whole room. 

3. Nasal symptoms. Thin yellowish-white mucous dis- 
charge, at first scanty, but becoming profuse, acrid excori- 
ating, epistaxis, unfavorable. The deposition of the pseudo- 
membrane may commence in the nostrils before any is seen 
in the fauces. 

4. Symptoms of the larynx. As the disease progresses, 
we may observe .hoarseness, total loss of the voice, cough, 
croup, (in all its dreadful utterances), suffocating spells; 
livid complexion; embrassed, sawing respiration, up to the 
final issue. 

5. Glandular Symptoms. The tonsils are almost always 
considerably swollen, and upon them, as a rule, the pseudo- 
membrane makes its first appearance. But the parotid and 
submaxillary glands swell also, and all the surrounding lym- 
phatics enlarge. 

6. Brain Symptoms. In light cases the cerebral functions 
remain undisturbed ; in severe cases we find that the mental 
faculties rather brighten up, except where there is hinder- 
ance to the free circulation of blood to and from the brain by 
those abnormal swellings about the neck, under which cir- 
cumstances the patient sinks gradually into drowsiness and 
stupor. 

7 Gastric Symptoms. Mostly entire loss of appetite, 



63 HOMOEOPATHIC FINDINGS IN DIPHTHERITIS. 

great thirst: sometimes vomiting of in^esta ; diarrhoea. But 
in a number of cases there is neither vomiting nor diarrhoea. 

8. Eruption. Rash on the skin, resembling sometimes 
measles, at other times scarlet fever; it breaks forth some 
times at the begining, sometimes at a later period ; in a num- 
ber of cases it does not appear at all; it may last only a few 
hours, or remain a longer time, or reappear, after having 
been absent for several days. It differs entirely from scarlet 
fever in that, it is never followed by desquamation of the 
skin. 

9. Hemorrhage, either from the nose, month, or fauces, 
is a bad sign; and when occurins as a sort of purpura, in 
the worst forms of the disease, a fatal one. 

10. Urinary Symptoms, presence of albumen is not con- 
stant ; in some cases only at a later period; in bad cases it 
probably exists from first to last. The microscope shows 
casts of uriniferous tnbuli by which the so ealled brights 
disease is characterized. 

11. Febrile Symptoms, vary much in intensity. In a 
number of cases the highth of the fever seems not at all pro- 
portioned to the severity of the attack, while in the other 
cases it is ushered in from the begining, with violent fever 
heat, even into convulsions. Corresponding to this we find 
in many cases the pulse frequent, but weak; while in other 
cases it is quick, hard, and wiry. Very often the disease 
commences with chilly feelings, which are followed by heat. 
Mostly this heat abates in the morning, and increases again 
towards evening and through the night; in severe eases the 
fever is continuous. Its remission is scarcely ever marked 
by sensible perspiration. 

12. Great characteristic debility, character, I call it, be- 
cause the disease is marked by this symptom, fully developed 
from the outset. Before any loss of vital fluids has occur- 
red in any way, the patient is at once stricken down by a feel- 
ing of great prostration, showing that the disorder attacks 
the vital forces themselves. 



HOMOEOPATHIC FINDINGS IX DIPH THELITIS. . 64 

COMPLICATIONS, 

Are said to be scarlet f over, small-pox, rheumatism, pleuro- 
pneumonia, and venous congestion. Its : 

8EQUEL2E, 

Are — 1. Anaesthesia of the nerves of sensation. There are 
observations which show that it has taken months after the 
attack was over, before the patient recovered the normal 
action of these nerves. It sometimes leaves all the cutane- 
ous nerves in such a state that external pressure is little ob- 
served ; sometimes this want of sensability is limited to one 
finger. Trousseau, mentions the loss of sensibility in the 
velum palate, which was characterized by an inability to talk 
clearly and to swallow. It is quite remarkable that this an- 
aethesia of the nerves of sensation sometimes will be inter- 
rupted by spells of hyperesthesia, so that even the slightest 
impressions become painful and unbearable. Also the nerves 
of special sense may thus remain impaired for a long time. 
Most frequently we find the nerves of the lower senses af- 
fected ; tasie, smell, and touch ; although the higher senses, 
sight and hearing, are not excepted. But all these forms of 
anaesthesia are less persistent than similiar affections after 
scarlet fever, where lesions of the organs of sight or hearing 1 
are of a much graver nature. 

2. Akinesia. The motory nerves may also be affected, 
such as those of the arms, lower limbs, tongue or pharynx. 
There may be either hemiplegia, or paraplegia. In still other 
cases this paralytic state mav be combined with hyper-akinesia 
manifesting itself as trembling of the hand-, or as tottering, 
or reeling in walking ; as wry neck, or as rolling of the head 
by its own weight, which when once fixed, is kept immovable. 

3. Abscesses. Which may form in different parts of the 
body. Most frequently the glands of the neck supurate. 
Abscesses in the ears are not frequent, and in the lungs they 
have been observed only occasionally. 

4. Albuminuria. May continue a great while after the 
attack is over. 



(55 HOMOEOPATHIC FINDINGS IN DIPHTHERITIS. 

SPECIAL INDICATIONS. 

Often the mildest attacks in the commencement have re- 
sulted unfavorably. 

Bad signs are: The acrid discharge from the nostrils. 
The invasion of the larynx, or the development of dipthe- 
rilic croup. Hemorrhages from the nose and mouth ; pur- 
pura, petechias, diarrhoea and vomiting. Convulsions, com- 
plications with scarlet fever, measles and small-pox. Certain 
localities and seasons seem to be the occasion of more dan- 
gerous cases than others. 

In this school, this appears to be the best literature on 
this disease. We shall allow it to pass for what it is worth with 
out remark, till we come to an exhibition of what we deem 
the rational facts of this disease, and its treatment ; and then 
we shall freely criticise not only this but everything else 
which we find bearing on this disease, in this or any other 
school of medicine. As to accept as medical science, that 
which is not borne out by existing facts, sustained by intel- 
ligent reason, and demonstrated by experience ; is the pro- 
lific source of error in medicine, or ethics ; and reduces the 
practitioner down to the rotine imitator, and the school, to 
a synagogue of fables, though honored by men and up held 
by law. 

Ruddock gives the following: 

EPITOME OF TREATMENT. 

1. ''Mild cases. Aconite, Belladonna or Baptisia. at the 
commencement afterwards, if necessary, Mercury, Iodine, 
Nitre or Aconite. 

The treatment recommended in Quinsey and Croup, is 
often sufficient in Diphtheria if used early. 

2. Malignant Diphtheria, Kali, permanganicum, Muri- 
atic acid, Bichloride potassa, Arsenicum, Rhus. Sulphur, 
Digitalis for (enfeebled heart). Chinconidia or Quinine, 
for ('debility ). 

PROGNOSIS. 
Belladonna, mild cases rapidly recover, and more severe 



HO.VCEOPATHIC FINDINGS IN DIPHTHEIMTIS. 66 

ones often yield under this remedy when perseveringly ad- 
ministered in the ixtb, dilution. 

Hughs recommends a freer resort to the aid of Belladonna 
but very properly adds, 'That if decided improvement, has 
not resuked within forty-eight hours of commencing its use, 
or if the symptoms yield at first to the remedy, but soon re- 
turn, there is no advantage in persevering with it'. 

Acidium Mur. Malignant Diphtheria, with foul greyish, 
ulceration of the throat, fsetid breath and great general pros- 
tration. This remedy should bo used in a low dilution, in 
frequently repeated doses ; and locally as a paint to the throat 
or as a gargle, when the patient is able so to use it. 

Mercury-Iod. This remedy has proved of great value in 
this disease, and should be administered as soon as any diph- 
theritic patches are observed in the throat, or swelling of 
the glands of the neck. Difficult. swallowing, pain in, and 
swelling of, the salivary glands, and putrid sore throat, 
indicate this remedv. The lx or 2x trituration is the strength 
and form on which we place the greater reliance. 

Kali Pern tang anicum. Malignant Diphtheria, with ex- 
tensive swelling of the throat and cervical glands : pseudo- 
membraneous deposit, partially, or completely covering the 
fames; obstructed swallowing; a thin, or muco-purulent 
discharge from the nose, excoriating the parts ; thick ob- 
structed speech, and very offensive breath. ''There is no 
remedy with which 1 am acquainted that will so lapidly and 
surely remove the offensive odor of the diphtheritic breath 
as the 'permanganate. In this respect the chlorate of potassa 
closely resembles it", (Dr. C. H. Allen). 

The Permanganate, Condy's Fluids or Carbolic acid, 
should be used as a gargle, or wash to the affecud parts; or 
administered by inhalation, or the spray-producer . 

Baptisia and Phytolacca. Both of these American rem- 
edies are strongly recommended in diphtheria; the former 
has a more specific relationship with the blood-poison, and 
the latter with the local effects of the disease. No cases of 
diphtheria have occurred in our practice since we have been 



67 HOMOEOPATHIC FINDINGS IN DIPHTHERITIS. 

•acquainted with these remedies ; and we can only, there fore, 
recommend them on the authority of others. 

Arsenicum. In the last stages of the disease is of immense 
value, particularly when the prostration of strength is very 
marked, or is increasing; when there ure — oedema, putrid 
odor of the throat and air passages, and tenacious fsetid dis- 
charge from the lining membrane of the nostrils ; ammonia 
carbonate, is also an important remedy in malignant cases, 
and may be administered alternately with Arsenicum. 

LOCAL TREATMENT. 

In the commencement a large, thick, hot poultice should 
be applied around the throat; but in advanced severe cases 
external applications are inadmissible, as they rather tend 
to increase the oedema and extend the disease. The inside 
of the throat may be steamed by the vapor of water and acetic 
acid (a wine-glassful of strong vinegar to a pint of water.) 

A very abundant and faetid false membrane is liable to 

reinfect the system secondarily, and hence such solvents as, 

acid deodorisers, acidum mur. kali permanganicum, gUcei- 

ine. acetic acid, and especially dilute carbolic acid, are of 

the greatest value. 

Tracheotomy, is sometimes pei termed, but it can hardly 
be expected to save life, in as much as the disease and false 
membrane often extends down the trachea to the bronchi, 
beyond the reach of the operation. It is only permissible 
in extremes. 

Warm Vapor. The temperature of the room should be 
maintained at 68 ° Fahr. and the atmosphere made moist 
by the steam from a kettle with a long spout constantly on 
the tire. Such an atmosphere is easily secured by forming 
a tent with blankets over the bed, and then bringing a pipe 
to convey the steam under it. 

Warm Baths. These are valuable accessories. The skin 
is hot and dry, the urine is often suppressed, the bowels 
confined, and thus the poison is retained in the system. 
Warm baths, and the free use of cold water as a beverage, 



HOMCEOPATKIC FINDINGS IK DIPHTHERITIS. 68 

often restore the functions of the skin, the bowels, and the 
bladder. 

Ice. If vomiting occur, constantly sucking small pieces 
of ice tends to allay it ; it also affords comfort to the patient, 
and as a diluent, favors the action of the kidneys. 

Diet, etc. The strength of the patient must be well sus- 
tained, from the very commencement of the disease, by 
nourishment, and he lwust be urged to swallow it in spite of 
the pain which it occasions. Kgg* beaten up in milk, or in 
brandy with water and sugar; beef tea slightly thickened 
with rice, or, pearl barley; arrow root, or sago with port or 
Sherry. Sudden or extreme prostration requires wine or 
brandy. 

Children who persistently refuse to swallow, must have 
nutritive injections in bad cases. Dr. Kidd recommends the 
yolk of an egg beaten up with a table-spoonful of new milk, 
and two teaspoonfuls of fresh essence of rennet, or an ounce 
of extract of beef with a scruple of pepsin. Injections, (about 
one ounee at a time) should be commenced, if necessary, 
immediately the true character of the disease is recognized, 
and repeated every two to four hours. 

CONVALESCENCE. 

Much caution and patience are required during convales- 
cence, as relapse are prone to occur. Nourishing diet, rest 
and change of air, are of great utility. Nothing does so much 
oood as a thorough change of air. 

PKEVENTIVE MEASUEES. 

The cesspools should be emptied, and if two small or de- 
fective, new ones built. The house, water-closets, and local 
drainage should be thoroughly examined, and imperfections 
scrupiously rectified : also, if necessary, chloride of zinc, or 
lime constantly kept therein, and thrown down the drains. 
All dust holes, and accumulations of refuse should be clean- 
ed away; while a plentiful supply of water should be kept 
in the house, and every room regularly, well cleaned, white 
washed and thoroughly ventilated. 

While Prof. Herring, M. D., gives the following: 



69 HOMOEOPATHIC FINDINGS IN DIPHTHEKITIS. 

THEEAPEUTIC HINTS. 

Bryonia. The patient is quickly prostrated, shuns all 
motions and complains, on moving or being moved, of pain 
everywhere; white tongue: feeling of dryness in the mouth 
without particular thirst, or else desires large quantities of 
water. 

Belladonna. The patient is restless, complains of sore 
throat ; the fauces look highly inflamed; the pupils are en- 
larged ; he feels drowsy, and yet unable to sleep; starts sud- 
denly out of sleep. 

Lachesis. When, after belladonna, by next evening there 
is no marked change for the better ; or when he is even worse 
in the morning after some sleep, with a decided develope- 
ment of those skinny patches on the tonsils ; worse on the 
leftside; or when croupy symptoms appear, and the patient 
cannot bear anything touching his neck or throat. 

Lycopodium. When the aspect of the fauces is rather of 
a brownish redness, worse on the right side, and worse after 
swallowing warm drinks ; when the nose is stopped up, and 
the patient cannot breath with his mouth shut; he keeps his 
mouth constantly open, slightly projecting his tongue, which 
gives him a silly expression; the nostrils are widely dilated 
with every inspiration ; on awaking out of a short nap he is 
awfully cross, kicks and behaves naughty, seemingly dream- 
ing, with open eyes ; frequent jerking of the lower limbs 
with a groan, awake or slumbering ; great fear of being left 
alone. 

Rhus Toxicodendron. When ihe child is restless, wants 
to be carried about, wakes up every now and then, complain- 
ing of pain in the throat; when a bloody saliva runs out of 
the mouth during >leep ; when the parotid glands are a good 
deal swollen ; when there are transparent, jelly-like discharges 
from the bowels at stool, or afterwards. 

Apium Virus. Great debility from the begining ; the 
membrane assumes at once a dirty-gravish color ; there is 
puffyness around the eyes ; pain in the ears, when swallow- 
ing; an itchy stinging eruption on the skin; a sensation of 



ECLECTIS, AND DIPHTHERIA. 70 

weakness in the larynx; numbness of the feet and hands and 
even paralysis. (Never does good either before or after 
RhusTox/. 

C antharides . Too copious or difficult urination ; the urine 
contains shreds or easts of uriniferous tubuli ; extreme pros- 
tration, sinking, death-like turns; irritable looking rash upon 
the skin or shining through the epidermis. 

Arsenicum. Great restlessness, constant desire for cold 
drink, but takes little at a time, or better by drinking hot 
water ; all symptoms worse about mid-night. 

Natrum Muriaticum . Swelling of the submaxillary glands 
and the lymphatics; ma]) tongue; burning in the throat; 
after the application of caustics, especially nitrate of silver. 
(In different regions of Pennsylvania, a weak solution of 
kitchen- salt was used during the last epidemic as a gargle 
with great success). 

Tartarus Emetic, difficult breathing, gasping for air; rat- 
ling in the chest; retching, vomiting of tenacious mucous ; 
small circular pat"hes, like small-pox pustules, in and upon 
the mouth and tongue; oedema of the lungs. 

Nitric Acid. Uicers in the mouth ; corroding discharge 
from the nose: intermiting pulse." 

CHAPTER, IX. 

ECLECTICS, AND DIPHTHERIA. 

This school of medicine claims to represent the "Reformed 
practice,'" on this continent; and some of their writers claim 
this, as the >* American practice" , while others are intensely 
tenacious of the term "Eclectic". That this school, like its 
twin sister Homoeopathy, has done much in the past half 
century, to modify the barbarous practices of the day, admits 
of no denial; that it has outstriped Homoeopathy, in its de- 
velopment of vegetable remedial agents, also, cannot be de- 
nied. That it has done, and is doing a noble work in demon- 
strating the general noxious properties of nearly all mineral 
agents, and in bringing forward vegetable remedies to take 
their place, till all schools are now interested in this great 



71 ECLECTICS, AND DIPHTHERIA. 

Reform, are facts with which a reading public are becoming 
quite familiar. 

It is, however, much to be v egreted, that those reforma- 
tory measures have been, and stili are, confined to remedial 
agents, and to those alone ; while reforms in surgery, ob- 
stetrics, pathology, diagnosis, and all the attendant branches 
which form an essential part of medical scienee as a whole, 
are as imperatively demanded ; while perhaps, in no depart- 
ment of medical science is reform more forceably demand- 
ed than in its nomenclature. A science aiming to be exact, 
must use exact terms, to express exact ideas ; or else suffer 
from misunderstandings, bickerings, jealousies, confusion 
and schools. One of the grandest steps in the advancement 
of medical science will have been taken, when medical men 
can learn to lay aside all unnecessary verbage, and say just, 
what they mean, and mean just what they say. 

That any seet, or school is entittled to the appellation of 
"medical reformers", who have simply induced a change in 
one particular branch of medicine, however, important that 
may be, is what I am disposed to doubt. Better wait till 
reformatory measures become so manifest, that the public 
concede the reformation, and apply the term, and then it can 
be appropriated with a better grace. But while so many old 
methods have to be employed, and so many old and imper- 
fect, vehicles used to express these methods — so much that 
is paradoxical and absurd in all schools, in fact while our 
reforms still need reforming, let us be contented to be known 
as physicians, standing on the highest attainable plain of 
medical science, but still aspiring to nights, by new methods 
made attainable, still beyond. Ever remembering that an 
irrational eclectic, is no better than a like irrational Homoeo- 
path, or Alopath ; and that it is only the rationality, of 
the individual practitioner that can or will in this age, se- 
cure his claim as an advanced thinker in the medical litera- 
ture, morals, ethics, or practice. It is not fine spun theo- 
ries, or high sounding pretentions, that the public want, 
they care as little for the remedial agent employed : it is 



ECLECTICS, AND DIPHTHERIA. 72 

results they want. When sick the best practitioner, is the 
one, of any school, who gets them well in the shortest 
possible space of time, prevents suffering and saves ex- 
pense. In this fight the Rational practitioner of any school, 
who can lay aside school, to save his patient, in the end is 
sure to win. 

That Rationalism in medicine, is confined to the eclectic 
school, is a proposition w T hich cannot be admitted. The ad- 
vanced thinkers of all schools feel its importance;, and are 
begining to struggle for its attainment. In the not far dis- 
tant future, the physician who cannot, or will not give an 
intelligent reason, cogent to ordinary perception, will be 
compelled to stand aside, while the one who can give a rea- 
son, takes his place. The day for general diagnosis, and 
promiscous, or what is vulgarly called the "shot-gun prac- 
tice," is nearly past. People claim the right to know the 
'productive cause of disease, the pathological condition de- 
veloped by it, and the physiological action of the remedies 
employed to combat or remove it. Hence, the true medical 
Reformer, is the one who takes this advanced stand, and is 
prepared to assign a better reason than the mere teachings 
of schools, or the findings of books for the existence of dis- 
ease, or his methods of removing it. 

The literature of this school, and this disease, is limited, 
and very far from uniform, as to origin, or method of treat- 
ment, and so long as each individual practitioner persues his 
own method, it is self evident that the best method of treat- 
ing the disease has not been attained, or if attained, has 
not been adopted. Hence, I shall have to select the writings 
of the most learned and successful methods of individual 
practitioners of this school; and we cannot, even assume 
that these represent the teachings of the school, as this school 
claims no one writer as standard medical authority. True, 
Scudder, and Newton, have both published works on theory 
and practice. But the mere idea of a graduate of Bennett, 
pinning his faith to or following the suggestions of the oricle 
of Cincinatti, would be the hight of folly. Or, to expect a 



73 ECLECTICS, AND DIPHTHERIA. 

graduate of Se udders school, to recognize as authority, 
Newton, of New York, would be regarded as equally absurd. 
Buchnnnan of Philadelphia, is unquestionably the most ad- 
vanced writer, and practitioner, claiming filiation with this 
school, but since his incarceration (wright or wrong) he is 
denounced by all schools, to such an extent that it is almost 
unsafe to quote his opinion, for fear ot meeting with exe- 
crations on every hand. Yet, I fail to see that a legal pro- 
cess, justly executed, would invalidate a recognized literary 
standing, or render void conclusive medical findings, well 
sustained by scientific investigation, and demonstrated hy 
daily experience. 

Hence, looking at the matter from this stand point, I shall 
use him if occasion presents, and use him as one of the most 
intelligent writer of this school. Though he were dead and 
in perdition, if 1 could use any thing he had said or done 
to benefit the race, I should not hesitate to do so. 

Heneri Senoir, M. D., says — "The successful treatment 
of every disease must be founded on an intelligent under- 
standing of its essential character. The profession now re- 
gards diphtheria as a filth disease, and the general opinion is 
that it has its birth in decomposing vegetable and animal 
organism. 

But the precise manner in which these germs are evolved 
is vet an unsolved problem, and yet one of momentous con- 
sequences to the highest interest to mankind. If we knew 
the forces under which the passive agent acquires aggressive 
power, we perhaps could eradicate this disease from the 
earth. The microscope, has, however, thrown some light 
on this point — the sporules from which this malady is de- 
veloped are now known to belong to the animalcule class. 
These sporules attach themselves to the mucous membranes 
of the fauces and larynx, and excite irritation. In this ex- 
udation the sporules with great rapidity find their way into 
the blood and rapidly consume its oxygen; the consequence 
is that the albuminoid elements of the blood not being vital- 
ized aie not appropriated by the system and consequently 



ECLECTICS, AND DIPHTHERIA. 74 

over lead it. These albuminoid elements, if not removed 
from the blood, soon take on a retrogressive metamorphosis 
and develops a diphtheritic- typhus, that imparts the fatal 
consequences of this disease. 

If these conclusions are founded in truth and goodphilos- 
aphy, there is no doubt that all depressing agents can only 
increase the mortality; and the folly of applying irritating 
caustics to the throat, as also, tearing loose the false mem- 
brane with forceps, is evident. If the disease be originally 
a local one, the importance of such topical applications as 
will destroy every sporule must 1 e admitted. Perhaps at 
the earliest period of development such application might 
terminate the disease, but this period mu-t be very brief : 
the sporules soon penetrate below the mucous membrane, 
the blood, and then the disease becomes constitutional. Of 
course no local treatment can reach the pathological conse- 
quences of a constitutional disease; nevertheless, even after 
this event, the destruction of the sporules will prevent a furth- 
er immigration of them to the blood. The indications then 
are, to destroy the sporules and to oxygenize the blood. 
These indications are well attained by ozone, with a higher 
degree of success than by any other mode of treatment. 
Before the development of the typhus symptoms, quinine 
and sulphurous acid are indicated. They should be given in as 
large doses as the stomach can comfortably bear. To them 
carbolic acid may be advantageously added. Under this 
treatment the mortality will not exceed two or three per 
cent. Chloride of Potassium has been extensively used both 
internally and externally, without any definite view of its 
therapeutical or toxical consequences. For some time I used 
it, but found my patients did not do as well as I anticipated ; 
the urine became albuminous and blood poisoning was much 
more strongly marked than it had ever been while using car- 
bolic acid, sulphurous acid and quinine. I consequently 
avoided, in future, the use of chlorate of potash, but watched 
the results in the hands of physicians, and am convinced in 
this disease, as also in scarlet fever, it is the cause of a large 



75 ECLECTICS, AND DIPHTHERIA. 

per cent, of the fatality attending them". See note "A" 
under Rational Treatment. 

John Bright, M. D., of Ohio, says — Jt appears to me, 
that at the commencement of the attack, there is hut slight 
congestion of the mucous membrane of the pharynx, accom- 
panied with slight constitutional disturbance; but, in a few 
hours, the membrane puts on a livid appearance, and runs 
rapidly into the gangrenous state; and that the false mem- 
brane is a deposit of layers of lymph in the early stages of 
the disease, which soon looses its vitality, and acts as an ex- 
traneous body, thereby preventing the parts from perform- 
ing their natural functions. Accompanying this change, 
great depression of the vital powers of the system take place. 

Now, whence arises this rapid and fatal change in a few 
hours? Is it not from meterological cause? For it is certain 
that locality has but little to do with it. It has been as se- 
vere in high and dry situations as in low and damp; in iso- 
lated dwellings, and crowded cities ; in clean and well drained 
places, and the reverse. Therefore, ought we not to look 
at the atmosphere as producing these rapid changes, acting 
on the blood, occasioning the development of the oidium 
albicans, gangrenous condition of the throat, accompanied 
with an extremely low and depressing type of fever, from 
which the patient rapidly sinks into a state of extreme and 
fatal exhaustion. It therefore appears consistent with path- 
ology to administer a most powerful antiseptic remedy, to 
act promptly both locally and constitutionally. After taking 
the above view of the disease, I beg to submit to my medical 
brethern the plan of treatment which, I am happy to say, 
I have found very successful. 

I had under my care several cases in the fall of 1877 and 
again in the autum of 1878. Those of 1877 occurred in the 
town and neighborhood of Pottsville, and those of 1878, in 
a new building, an asylum for the reception of children who-e 
parents died young; consequently, their offspring were not 
constitutionally the best fitted to resist so formidable a disease. 



ECLECTICS, AND DIPHTHERIA. 76 

The treatment I adopted in all cases under my care was 
as follow-, for children: 

B Solutionis chlorinii, J ss ; 

Syrupi simplici, % ss ; 

Aqua distillatae __ 3 vj. Mix. 

Fiat, gargarism a scepe utendum. 

R Solutionis chlorinii, gtts. iv: 

Syrupi aurahtii, 3 j ; 

Aqua distillatae ad. , J ss. Mix. 

Fiat, haustus 2nd. quague bora sumendus. 

The dose to be increased according to age. Quinine was 
given in doses of one grain and upward, according to age. 

The diet, to consist of concentrated jellies, strong beef- 
tea, wine, etc 1 '. 

See note "B" under Rational Treatment. 

Dr. Miller, of Michigan. — '"Diphtheria is a disease much 
feared by parents, and much dreaded by physicians. It is 
characterized by a false membrane, forming in, and adher- 
ing to, the mucous membrane ; and during the progress of 
the disease may not only form on the tonsils, pharynx, lar- 
ynx, anterior and posterior nares, but may also form in the 
rectum and vagina, or any place where there is a mucous 
membrane, or it may form on an abraided surface. The 
membrane mav be found in the <rall-bladder". After de- 
tailing its supposed history, very imperfectly he adds. "Its 
attacks are mostly upon children, and those between the ages 
of one and ten years are the ones the most apt to take the 
disease, and the greatest mortality is in the second, third 
and fourth years. Scrofulous children, and those weakened 
bv previous disease, and those suffering from catarrh and 
other forms of throat affections, are the ones the most ex- 
posed to it. In fact, family constitution favors its develop- 
ment and determines its termination. 

When the false membrane extends down into the trachea 
the case is very apt to prove fatal. Sometimes death results 
from the mechanical obstruction to respiration, while other 
cases prove fatal from pure blood poisoning, as manifest 



77 ECLECTICS, AND DIPHTHERIA. 

thiough the nervous system, the local symptoms in the throat 
having to a great extent disappeared, leaving both food 
and air passages free and open. 

At first the membrane may be easily detached, but is soon 
reproduced. In the later stages of the disease the membrane 
becomes thick and more tenacious, presenting when detach- 
ed a bleeding surface. 

CAUSES. 
"We attribute the cause to a peculiar or specific miasma, 
malarial germs — Oidium albicans, and yet we know t hat- 
diphtheria has prevailed as an epidemic, and has proved very 
fatal, in localities where no malarial poison was known to 
exist. But if we go into these localities where they seem 
to be most exempt from malarial diseases, we need but ex- 
amine the drainage of the street, the filth in the back yards, 
the cast-off and impurities in sinks and back-houses, the un- 
ventilated condition of cellars, which often contain much 
damp and decayed vegetation, and but look into the sleeping 
apartments of children, where four, or five children are pro- 
miscuously thrown together, and we know that this poison 
can be carried many miles in the atmosphere, we can I think 
thus trace the cause of the scourge back to malarial poison. 

SYMPTOMS. 

The symptoms in diphtheria vary greatly in intensity in 
different cases. Generally in the commencement of an ep- 
idemic the disease is more severe and fatal, and the symp- 
toms are more violent, than when the epidemic is abating. 

W T hen there is great external swelling of the neck, which 
indicates a grave form of the disease, it is regarded as an 
unfavorable sign. The invasion of the disease may be grad- 
ual. It often may be, but, a slight degree of chilliness, 
with rigors; succeded by slight headache, languor, loss of ap- 
petite; yet the patient, if old enough, may play, or walk 
about the house as if affected by nothing more than a cold, or 
temporary ailment. In other cases the invasion is more ab- 
rupt and severe; great febrile reaction, heachache, pain in 



ECLECTICS, AND DIPHTHERIA. 78 

the ears, aching of the limbs, and a loss of strength, in fact 
the prostration is so severe and rapid that the p ttient, at 
on^e, is compelled to goto bed. 

In some cases the patient may become convalescent, then 
suddenly be taken worse, and in a few hours be a corpse. 

In diphtheria the tonsils are inflamed and assume a dark 
mahogany color, about the second day they are spotted with 
a dirty-greyish exudation of various thickness ; these spots 
soon spread over the soft palate, mires, fauces and in some 
cases extend down into the oesophagus and larynx. The 
throat is sore and swollen, so that sometimes deglutition is 
very diticult. The tongue is covered with a moist fur ; some- 
times more or less of the exudation appears on it, the appe- 
tite is poor, and the bowels loose. 

The disease may prove fatal veiy early, simply by reason 
of the vital importance of the parts affected. 

TREATMENT. 

In the treatment of diphtheria We should keep prominent- 
ly before our minds that the important part of the treatment 
is to combat the blood poison. And while local applications 
to the throat are very essential, they are only seeondarv in 
importance to the constitutional treatment. Sometimes the 
decomposition of tissue is so great that it requires the speedy 
application of remedies to arrest this decay, or speedy death 
results. 

The treatment, of course, varies, according to symptoms. 
First, I would give a cathartic to clear the stomach and bow- 
els. Then aconite alternated with baptisia every two hours, 
the aconite to control the circulation, and the baptisia as an 
antidote to the poison. If the baptisia is given sufficiently 
early in the attack, the more grave symptoms which would 
demand other antiseptics may occur. Should there be any 
symptoms indicating congestion of the nervous centres, I 
would give belladonna. 

LOCAL. 

As a local treatment I would swab, the throat with diluted 



79 ECLECTICS, AND DIPHTHERIA. 

tincture of haptisia, being very careful not to tear loose the 
false membrane, alternated with a gargle of chlorate of po- 
tassa, using vinegar packs on the neck; keeping the room 
at an even temperature and well ventilated. 

1 would purefy the atmosphere and prevent the spread of 
the disease so far as possible, by the use of an antiseptic, 
such as bromo-chloralum, by wetting clothes and hanging 
them in the room". See note, "C," under Rational Treat- 
ment. 

W. 0. F. Bascome, M. D., of Hamilton Bermuda, of 
the West India Islands, constributes the following — 

"The unusual success which has attended my treatment in 
twenty cases of diphtheria has induced me to contribute the 
following. Accepting the theory (which does not admit of 
a doubt ), that diptheria is a blood disease of an asthenic char- 
acter, showing itself locally, by a membranous exudation in 
the throat, and requiring from this fact, a sustaining treat- 
ment; for an adult I give the following, in doses suitable to 
the age, smaller doses to children. 

R Tr. Fern chloride, - 3 ij ; 

Potass chloras, _. .. 3 j ; 

Sulph. quinia, __ T) j; 

Acid sulph. aromat., 3 j; 

Glycerine, 3 iij ; 

Aqua, - ...„, 3 hj ; 

Tinct. aconite rad .. 9 j. Mix. 

Sig. Teaspoonf ul three times every day ; and use as a 
gargle every hour ; also strong beef-tea, soups, milk, cream 
eggs, whiskey as often as the patient can take them, and as 
much as the stomach can bear, or retain. External applica- 
tion "fat meat" to the throat. See note, "D" under Ra- 
tional Treatment. 

I.J.M. Goss,M.D., L.L.D., Ga. — Publishes the 
following: "Diphtheria, now so prevalent in many parts 
of the south, ma} 7 be traced back to the days in which Homer 
lived. It prevailed as an epidemic in Holland, in the sixtenth 
century, and was noticed by Dr. P. Forest. About the close 



ECLECTICS, AND DIPHTHERIA. 80 

of the sixteenth century it also prevailed in Spain, and prov- 
ed very fatal; it was called Grotilla. Jt has occasionally 
prevailed in various countries ever since, but it never ap- 
peared in the United States, till some years ago. it appear- 
ed in Georgia, about 1861, or 18(52, and was very fatal at 
first, as the profession did not understand its true pathology, 
Consequently, they did not treat it specifically. No disease 
can be successfully treated unless the pathology is under- 
stood, for the remedy must be suited to the pathological 
peculiarities of the disease. 

DESCRIPTION. 

Diphtheria is distinguished by redness and soreness of the 
fauces, together with an exudation of a plastic material on 
the mucous membrane of the fauces, especially on the tonsils, 
and frequently extending to the mires. It is doubtless albu- 
men separated from the blood by the diseased action set up 
in the parts, which albumen is partially organized by a mor- 
bid morpholysis, a downward metamorphosis. 

There is generally some fever. Sometimes the fever is 
high ; difficult deglutition : the fauces are of a dark mahnuony 
color, with spots of greyish-yellow exudation appearing on 
the tonsils first, thence spreading over the entire palate, fau- 
ces, and not unfrequently over the posterior mires and entire 
cavily of the nose, and in some cases it. decends into the 
larynx and oesophagus. When the exudation is detached it 
leaves an inflamed, or even ulcerated surface beneath, which 
is again recovered with the exudation. But when ii is re- 
moved by the proper local and- constitutional treatment it 
does not return. In the malignant form, this pseudo-mem- 
branous exudate dissolves into ichorous mass, under which 
the mucous membrane exhibits decayed shreds, or dark- 
colored crusts, emitting a very offensive odor. 1\\ many 
cases the submaxillary and parotid glands become inflamed 
and sometimes even the lymphatic glands are involved in 
the morbid process. In this form, we often have great pros- 
tration, and a typhoid condition of the system, which ter- 
minates fatally, unless properly treated at the commence- 



81 ECLECTICS, AND DIPHTHERIA. 

ment of the attack. There is a peculiar poison in the blood, 
locating by affinity, upon the mucous tissue, which poison 
must be a.ntidoted at the commencement. If the disease is 
suffered to progress a few days, it is apt to prove fatal. 

Its pathology is not well understood by the mass of the 
profession. It doubtlessly depends upon a poison in the 
blood which develops microscopic fungi, perhaps the di- 
plosporum fascum, which belongs to the genus pencilium 
glancum, much like the mould on bread. This fungi per- 
meates the tissue between the cells, and that causes the in- 
flammation and exudation, and finally the decomposition of 
tissue characteristic of the disease. Prof. Healliar, of Java, 
discovered this fungi upon the diphtheritic membrane. It 
maybe possible that they first start from decaying particles 
of food that lodge in the fauces; the atmosphere being in a, 
proper state for the production of the fungi compresses the 
vessels, and imparts a peculiar ferment to the parts that 
causes decomposition of structure, like many other poisons. 
We have this condition sometimes in wounds, or after sur- 
gical operations. 

TREATMENT. 

Holding the above pathological views, I have successfully 
treated this disease for several years. As there is always 
more or less febril excitement, I usually give aconite or ver- 
atum, according to the type of the disease ; that is, if there 
is typhoid depression, and a small, feeble, quick pulse, aco- 
nite; but if the pulse is full, strong and quick, then veratrum. 
The septic condition of the system should be met by bapti- 
sia tinctoria, in large doses, say 20 or 30 drops, if the symp- 
toms are urgent, at the same time the uealyptus globulus 
may be given in doses of 15 to 20 drops every two hours ; 
and a wash of one drachm of the tincture to one ounce of wa- 
ter, used as a gargle, or the surface penciled with the pure 
tincture every few hours. This treatment carried out will 
succeed in most cases. 

This paper from Dr. Goss, made its appearance in 1878. 
How far more recent investigations may have modified some 



ECLECTICS. AND DIPHTHERIA. 82 

of his conclusions, or changed his treatment, I have no means 
of knowing. See note "E" Rational Treatment. 

J. C. Gunn, M. D., though a graduate of both schools of 
medicine, is from that fact alone regarded as an eclectic. As 
a member of the Alopathic profession, cannot regard any man 
as strictly orthodox who dares to graduate in another school 
of medicine; as though an increase of knowledge was the 
worst of crimes. This writer even though not strictly Ec- 
lectic, either, in the restricted sense of that term, has made 
a noble effort to be rational, in evavy sense, and as a result 
perhaps no medical name on the continent, is a more famil- 
iar house hold word, than that of john c. gunn. 

After giving a portion of the history of this disease which 
is supposed to have ended the career of the Empress Jose- 
phine, and George Washington, gives the following as its 
most prominent, 

SYMPTOMS. 

Diphtheria is a peculiar kind of sore throat, though in 
some respects it resembles croup and quinsy ; yet in others 
it differs so much from them that it need never be mistaken 
for either. It is most common among children, though 
grown persons are quite liable to it. The patient is most 
usually, perhaps, taken in the morning, and generally with 
sensations of an attack of eold in the head, being somewhat 
drowsy, weariness through the joints, and usually more or 
less soreness of the throat, difficulty of swallowing, and turn- 
ing the head. A peculiar symptom is a sort of uneasy sen- 
sation, or, stinging pain, just inside the throat, opposite the 
angle of the jaw hone and under the ear, as though there were 
some small object lodged there. Soon there will be consider- 
able swelling and hardness of the glands of the throat ; sur- 
face appears bloated or swollen; the eyes perhaps a little 
red, swollen, or moist. The inside of the throat, at this stage 
will be found quite red, in children of a rose color, while in 
grown persons more of a dark red, or purple; the uvula, or 
palate becomes swollen and elongated, and thrre is generally 
a watery discharge from the nose, but no sneezing, or cough. 



H3 KOLECTICS, AND DIPHTHERIA. 

Usually there is but little fever, perhaps not any; but in 
some eases the disease is very sudden and alarming in its 
attacks, exciting the apprehension of the patient and friends, 
and may terminate fatally in a few hours. In such cases 
the symptoms are all intense. 

The next symptom that may be noticed, is the appearance 
of a whitish spot, apparently somewhat swollen, bark in 
the fauces, or throat, perhaps several such spots; soon these 
spots run together, and form what is known as the diphthe- 
ritis, or diphtheritic pellicle*. These patches, some what 
like ulcers, though generally of a whiter appearance, may 
he located on the pharynx, the tonsils, or the uvula. As the 
disease progresses, the diphtheritic pellicles, which is a sort 
of white, false membrane, extends, more or less over the 
fauces, or back part of the mouth and throat, and swallow- 
ing becomes very difficult ; the glands of the neck and under 
the jaw become more swollen ; the tongue is pressed forward, 
and upward, the saliva escapes from the mouth, and the 
breath of the patient is generally very offensive. Swallow- 
ing now, especially of fluids, is very difficult, and dreaded, 
by the patient. If he sleeps, he will often awake with con- 
vulsive coughing, caused by the saliva escaping into the 
windpipe instead of passing into the oesophagus, or throat. 
This disease may be known from quinsey by the manner in 
which the patient swallows, it being difficult to do so in both 
cases. In quinse} r , the patient usually shuts his eyes, leans 
his head forward and ^wallows with a quick, spasmodic ef- 
fort, or jerk; while in diphtheria, the face and chin are rais- 
ed, the eyes stare wide open, and the act of swallowing is 
done as slowly and easy as possible, so as apparently to 
allow 7 the substance to he swallowed to pass along the tongue 
slowly over the epiglottis to the oesophagus. 

Th< j act of swallowing in quinsy, as well as in ordinary 
sore throat, seems to cause severe pain; while in diphtheria 
pain does not seem to be the cause of the difficulty. 

Diphtheiia may be easily known from croup, from the 
fact that it is not attended with cough, while a peculiar sort 



ECLECTICS, AND DIPHTHFRIA. 84 

of cough is one of the characteristics of croup. In diphtheria, 
the nose also seems to be stoped up, or discharges a watery 
transparent fluid, which gives to the voice a sort of nasal 
character, not met with in croup, quinsy or any other form 
of .-ore throat, 

Jn the course of the disease, if it yields to treatment, or 
the constitutional strength of the patient, that is, as the pa- 
tient grows belter, the pellicles, or white membrane peels 
off in spots, or strips, and is discharged from the mouth 
along with the saliva : sometimes in quantities really aston- 
ishing. As it may he that after one pellicle is thrown off, 
another, and even a third one may form, generally whiter 
and thiner than the first, and finally thrown off in the same 
way. After this diphtheritic pellicle or exudation has been 
thrown off. the parts from which it has been removed will 
appear shriveled and greatly shrunken, as though a portion 
of the substance had been removed. Yet it will be found 
on examination, that no abrasion of the surface, or ulcera- 
tion, has taken place. 

TREATMENT. 

This is in many cases a very dangerous disease, yet it may 
be vevy successfully treated in almost every case, if taken 
in time, and that, too, with very simple remedies. All ac- 
tive, harsh, or depleting measures should be avoided, as not 
only unnecessary, but actually injurious. Avoid, therefore, 
blood-letting, active purging, and emetics. Eat nothing 
but the mildest kinds of food, as gruel, porridge, custard, 
soft boiled eggs, boiled rice, and the like ; remain quiet in a 
warm room, and drink no cold water. Apply a bandage of sev- 
eral thicknesses of flannel round the throat and jaws, wet 
with a strong solution of common salt, in warm water, sprink- 
ling freely of salt in between the folds of the flannel, so as 
to keep up its strength and moisture ; renew 7 the application 
frequently, as warm as can be borne, and continue it for 
several days. Bathe the feet in warm water with plenty of 
ground mustard in it, and rub the feet and legs well. 

At the same time take internally the following prepara- 



^5 ECLECTICS, AND DIPHTHERIA. 

tion: take of Biniodide of Mercury, three grains ; White or 
Loaf sugar, sixty grains, mix, or triturate, or rub well in a 
glass, or wedge wood mortar till thoroughly pulverized and 
mixed ; and give of this powder about one to two grains, or 
about half as much as will lie on a three cents piece, once 
in two to four hours, according to the urgency of the symp- 
toms. At first you might give a powder once in two hours, 
till five or six are taken; then once in four hours will be 
often enough. At the same time put twenty drops of tincture 
of belladonna, into a tumbler of water, mix it well by stir- 
ring it with a teaspoon, and give a teaspoonful of this every 
two hours, or in alternation with the powders. These two 
remedies may be considered a specific in this disease, and will 
cure nine cases out of every ten, if not ninety nine in every 
hundred if properly given and persevered in. See note »<F' 
under Rational Treatment. 

Dr. John Buchannan. In his "Centenial Practice" page 
66 says : 

Diphtheria, an epidemic and contagious disease, depend- 
ing upon a specific poison which primarily acts on the nerv- 
ous system, as is shown by the vital depiession, loss of pow- 
er, and secondarily on the blood and characterized by the 
exudation of false membrane on the tonsils and throat. 

The peculiar morbific poison seems to find a favorite sphere 
of action among strumous, syphilitic, psoric, or other broken 
down constitutions. 

There is an undefined period of incubation, followed bv 
rigors and a continued fever, pain in the head, back, calves 
of the legs, general derangement of the secretions; tongue 
coated brown, dry, dark hue at the root ; accellerated circu- 
lation ; sore throat, stupor, drowsy, often delirium, variable 
in its duration, id ways attended with danger. 

The force of the poison seems to be spent upon the mucous 
membrane of the throat, and fauces, often times the tongue, 
and cheek. Little w T hite spects, like blisters, make their 
appearance here and there, isolated, white. By and by they 
coalesce in several, or one large patch, which in a few days 



ECLECTICS, AND DIPHTHERIA. 86 

fill* up with serum; a little later it becomes greenish, or 
gangrenous, forms a large patch like a false membrane. It 
may break down, or be expectorated in a mass. Through- 
out the formation of this small membrane, the breath is re- 
markable for its faetor, and there is great danger of suffo- 
cation. 

In other cases the symptoms are ushered in with violent 
vomiting of a thin yellowish white matter, of extremely of- 
fensive character, and perhaps purging of a like fluid. 

This is usually followed with prostration and stupor. The 
skin is hot, pulse 100 to 104; tongue, brown dark hue; great 
thirst, drinks with greediness. 

The odor of the breath is very characteristic and peculiar- 
ly offensive. It is infected by a specific zymotic poison 
operating on the secretions of the part affected, as well as 
the blood and nervous system. 

The appearance of the throat (the tonsils, soft palate, 
back of the pharynx,) presents in some cases a white, shin- 
ing appearance, a tenacious fluid hangs from the velium to 
the tongue, and the same gelatinous substance covers all the 
back portion of the throat. 

After a few hours the condition of the patient changes, 
the stupor passes off and delirium takes its place; high fe- 
ver, quick breathing, shrill voice, cough, croupy symptoms, 
neck swollen and flushed, tongue coated, at first whitish 
spots, which conglomerate and form one thick plastic de- 
posite. 

If remedies do not act and the case progresses, the delirium 
subsides, the vital forces fail, choking and suffocation come 
on ; the sufferer tears at his neck with his nails, tries to 
open his mouth; retains the power of swallowing; purpuric 
spots on the extremities, muttering delirium, convulsions, 
and death. 

The diphtheritic poison, when once introduced into the 
human system, has two special and peculiar affinities, one 
to the nervous system and the other to the blood, and through 
that agency to the mucous structure. 



87 ECLECTICS, AND DIPHTHERIA. 

Diphtheria has a tendency to invade the respiratory pas- 
sage, nasal f'ossoe, the larynx and the trachea. Its charac- 
teristic feature is the effussion of the particular, plastic fibrin- 
ous material, in appearance resembling washed leather, 
thrown out in spots, which quickly coalesce, and when uni- 
ted gradually increase in consistency and thickness, firmly 
attached to the mucous membrane beneath, and if forcibly 
removed a new patch instantly forms and spreads to all the 
surrounding parts. When this membrane separates and be- 
gins to decompose, the breath becomes horribly offensive. 
its disappearance may be followed by ulceration, sloughing, 
o-angrene, or resolution. 

Diphtheritic patches have been detected on various parts 
of the mucous membrane, as the conjunctiva, vagina, rectum. 

The peculiar action of the virulent poison on the blood is 
to destroy its fibrine, hence hemorrhage is not uncommon, 
from the nose, fauces, bronchi, purpura, albuminuria-, death 
from exhaustion, hemorrhage, gangrene, asphyxia, embol- 
ism, sometimes a complication. Recovery under the best 
treatment is slow and tardy. There is generally persistent 
anaemia or leucocythcemia. The secondary affections are 
flabby heart, nerve affections, paralysis, neuralgia nnd am- 
aurosis from exhaustion. 

It can easily be recognized from scarlet fever by the coma, 
tongue, vesicles forming on the fauces, and the formation 
of the false membrane. 

PATHOLOGY. 

A terribly poisonous and destroying blood disease that 
causes diphtheritic patches on all the mucous membrane of 
the body. 

TREATMENT. 

If seen in the early stages there can be no doubt of the 
utility of an emetic of compound tincture of Lobelia. This 
is never indicated later. A spirit vapor bath, a general spong- 
ing every three hours with water medicated with hydro- 
chloric, acid. Diet — essence of beef, white of egg, cream, 



ECLECTICS, AND DIPHTHERIA. 88 

wine and beef-ten, brandy, and if the patient can afford it, 
champaigns and ice. The pulse must be kept at seventv-two, 
with Aconite and Belladonna; if that fail, Belladonna and 
Veratrum. Put the patient on tincture of ferri chloride and 
alternate with chlorate, or permanganate of potass ; for 
drink, wine or whey. If however a clotty condition of the 
blood is suspected alkali remedies, as ammonia, iodide p<>- 
tassa, sulphite of soda ; large doses of 1 tetucarium should 
be given to induce sleep, and if depression is threatened' 
rely on stimulants; if hemorrhage, iron. If there is great 
putresency, give jeast and milk. Locally to the throat ap- 
ply nothing but a piece of fresh beef, or plain dressing, as 
all applications are useless. At the commencement I have 
found inhalations of acid vapor excellent, five drachms of 
acetic acid to half a pint of water. For the exudation the 
inhalation of bromine or bichromate of potassa or sancmi- 
naria is most excellent. 

Fainting the exudation with equal parts of tincture of 
iodine and iron, once daily, has a good effect, keep up with 
the inhalations once in two hours. If the patient is able to 
gargle, then gargles of sulph-hydrastia and baptism, chloride 
of sodae, carbolic acid gargle. No violence should be used, 
as any thing that detaches the membrane is injurious. 

The patient should be kept rigidly in bed in the recum- 
bent position; temperature of the apartment seventy-five, 
to be kept moist by some antiseptic vapor, as permanganate 
of potass, chlorine, bromine, moist atmosphere : the bowels 
to be opened by enemas of beef tea and sweet oil. If there 
is suppression of urine, belladonna ; if swallowing is pre- 
vented, beef tea enemas; tracheotomy is often performed 
when exudation obstructs the larynx, but with no success. 

As soon as the acute affection is controlled, salt water 
baths, hydrastin, baptism, quinine, iron, mix vomica, phos- 
phorus, faradization; very generous blood elaborating diet; 
otherwise treat on general principles. 

Diphtheritic patches are frequently met with on the mu- 
cous membrane of the fauces, as a sort of subacute or chron- 



<S ( J ECLECTICS, AND DIPHTHERIA. 

ic affection. Unquestionably the best treatment is to paint 
the part, if within reach, with nitric acid, then use gargles 
of chlorate of potass* alternated with decoerion of bay berry 
and golden seal. Then put the patient upon alteratives and 
tonic>. A good alterative in those cases is the compound 
syrup of yellow dock and iodide potass ; a tonic, compound 
tincture of cinchona and nitric acid. The compound hypo- 
phosphites of lime soda and iron are invaluable. 

In all cases stimulants should be applied to the throat, 
externally, and the general health improved by all possible 
means." 

Such appears to be the best findings of the best minds of 
this school of medicine, no man has arisen among them as 
yet, who is accepted as a standard authority on Theory and 
Practice. Beech the founder of the school, perhaps conies 
the nearest occupying that honored position. Prof. John 
King, is a standard in therapeutics, and if he wrote on prac- 
tice perhaps would come as near being accepted as authority 
as any living man. In the absence of such authority, we 
have selected' the statements of their most successful prac- 
tioners, and intelligent and popular writers, to represent as 
nearly as possible their teachings. The careful and intelli- 
gent reader, will however, be impressed, not only with 
the peculiar manner in which they contradict each other, 
but the painful manner in which they contradict themselves. 
The one recommends an emetic in the inception of the dis- 
ease. Another condemns emetics in no measured terms. 
One, in one breath denounces all external applications to the 
throat in this disease, and concludes by tellinir us — "In all 
cases stimulants should be applied to the throat, externally." 
But more of this anon, see note "G." under Rational 
Treatment. 

There is another method coming into vogue with certain 
practitioners, which I shall give in conclusion : which I take 
from a late issue of the New York Medical Monthly ; headed. 

"Diphtheria Treated by the Galvano-oautery, which 
says: in a recent Editorial article on this question, the 



ECLECTICS, AND DIPHTHERIA. 90 

Therapeutic Gazette thus concludes: — (1.) The galvano 
cauterization of the diphtheritic membrane produces no pain, 
01 only a minimum one. (2.) The thoroughly cauterized 
part is rendered absolutely sterile, and forbids the develop- 
ment of microbic life. (8.) Fever appears soon after the 
cauterization. (4.) No inflammatory secondary effects set 
in. (5.) Every physician is able to execute the cauteriza- 
tion, even without an assistant. (6.) No constitutional 
medical treatment is needed in addition to the cauterization. 
(7.) Though the statistics of diphtheritic cases thus treated 
are of course, yet very limited, the thousands of ulcers of 
the cornea treated and cured in the same way, allow of verv 
favorable prospects regarding the treatment of diphtheria 
with the galvanic <-auterv." 

The third and fourth postulates appear some what para- 
doxical but with all the paradoxes of schools and schollars 
before us on the subject, it is not surprising to find some- 
thing of the same nature in this short paragraph. The Hy- 
dropathic treatment of this disease will recieve no notice at 
my hands. It is at such complete variance with the patholog- 
ical condition found to exist in the disease, that none but 
imbecile or mad-men would make the attempt to remove 
such a pathological phenomenon, by the application of water. 

We have now presented the reader with the best treat- 
ment of schools, for what is by all admitted to be one of 
the w T orst diseases with which the profession has to deal. 
That their best methods are imperfect, uncertain, and unsat- 
isfactory to themselves, is manifest to all. That any of 
them have attained to anything like scientific certainty is not 
pretended by any. Hence, after all these hundreds of years 
of the existence of this disease, no balm has been found 
inGilead — and still it may be said, "There is no physician 
there," who has attained to any thing of a Rational mode of 
treatment, or raised that treatment to any thing like a scien- 
tific deduction or certainty; and the reason for this failure 
is evident from the writings of all we have investigated, and 
produced. Not one predicates his treatment, on the path- 



91 RATIONAL T.REA'IMEKT OF DIPHTHER1TIS 

ology of his case. Not one gives ihe physiological, or ther- 
apeutical action of his remedies, or the pathological phenom- 
ena they are expected to combat or over-come. Hence, we 
have the indiscriminate mixing, shall I say jumbling, of acids 
and alkalies, tonics and stimulants, alteratives and anodynes, 
not only by different schools, but by the single practioner 
for the same patient. Showing a lack of careful investiga- 
tion ; developing a degrading empiricism in practice; and 
ending in uncertain, but dogmatic, excathedra statement, 
unbecoming in a profession claiming to be devoted to the 
best interests of humanity. 

We shall now give our notes and comments on the writ- 
ers introduced. We shall aim to be fair, courteous, and 
candid. If any writer animadverted upon, should think we 
had done him an injustic, or not correctly represented his 
views, he will always find us read}' to make any corrections 
necessary to place any and every man before the public in 
his own light. 

CHAPTER, X. 
RATIONAL TREATMENT OF D1PHTHER1T1S 

It has been frequently said, "There is nothing in a name," 
this may be true in a very limited sense, but the maxim has 
lonjr been the confusion, and curse of medical science. 

Every term has, and must have its precise, generally ac- 
cepted and well understood meaning; and custom renders the 
rules governing that meaning arbitrary and imperative. It 
has long been the bane of medical science that she has not 
been judicious in her selection of terms to represent diseased 
condition, and this lack of care has often made her appear 
ridiculous, when brought in contact with other learned pro- 
fessions. For instance "Scarlet fever" to represent a com- 
mon well known disease as though fever had a color, and 
in one ca.se wa^ "scarlet," in another "yelloiv." 

Tvphoid — the Greek word for Stupid, and "Fever" ex- 
citement. Hence, we have a disease designated by the par- 
adox "stupid excitement" &c, &e. So with the word in 



RATIONAL TREATMENT OF DIPHTHERITIC. 92 

general use to characterize this disease ; it is from the Greek 
root for, diphtheria meaning simply "a membrane," no 
more, and no less. Hence when we say a patient has got 
Diphtheria, we simply say he has got "a membrane " and 
who has not got one? But every man, woman and child who 
has got "a membrane" has not necessarily got an inflam- 
mation of "a membrane" which is an essential accompa- 
nyment of the diphtheritic phenomena ; hence, by the simple 
addition of the Greek afBx "itis;" inflammation ; we can 
make this term represent not a pseudo membrane, or false 
membrane, but an " Inflamed membrane" — or in other words 
it will represent an essential factor of a pathological condi- 
tion, and thus indicate a disease. Diphtheritic is certainly 
as elegant and euphonious as diphtheria. For myself, I 
shall use, in the future, as in the past, when speaking or 
writing of this disease the term, Diphtheritis : others can do 
as they please. When asked, what ails a patient, they can 
reply he has i6 a membrane ," if they wish; the ignorant may 
understand what thev mean, and the educated will recognize 
the fact, that the doctor has told the truth, if he has not 
answered their question. 

Note ik A." Doctor Lenoir — claims to have found sulphu- 
rous acid and quinine effectual in combating this disease, 
but finds that chlorate of potassium was not only not effect- 
ual in his hands, but has been equally ineffectual in the hands 
of others. But he assigns no reason for this — it is simply 
his observation, and there it rests. The reader will bear in 
mind the fact, that the normal composition of the secretions 
of the human body, are alkaline, and it is in these alkaline 
secretions, that this disease incubates, grows, and matures. 
In fact an alkaline secretion is essential for the incubation 
of the disease; hence, to increase the alkalinity of these 
secretions, is simply to fertilize the soil for the develop- 
ment, growth and maturity of the disease. This, the admin- 
istration of chlorate of potassium and its kindred alkalies 
does to a supreme extent. Consequently, it was to be ex- 
pected, that patients under this treatment would not "do 



!>3 RATIONAL TREATMENT OF DIPHTHERITIS . 

as well as expected." Had the Doctor taken a piece of the 
diphtheritic false membrane, and placed it in a seventy live 
per cent, solution of chlorate of potassium, in the evening' 
and found by morning it had grown to nearly twice the 
size it was when placed there, he would have found a reason 
for its failure as a therapeutic agent in this disease. It 
simply feeds the disease, instead of curing the patient. If 
this is not empiricism, I am at a loss for a term by which 
to characterize it. Experimenting with drugs, independent 
of their physiological action and indifferent to the patholog- 
ical condition of the patient. A minute investigation of eith- 
er, would at once, and forever preclude the possibility of 
their administration in this disease. 

Herald C Ernst's suggestion, in a previous chapter strikes 
the true key note to the rational treatment ot this disease. 
After referring to the mortality of children, and assigning 
various causes he adds "on the other hand, the free acid se- 
cretions of the mouth after the third month tends to hinde 
its recurrence after this period;" and if so why may not 
chanainor these secretions from an alkaline to a complete 
acid, prevent it altogether, or cure it when developed? Echo 
answers "why?" 

Note "Z?" — John Bright M. D., states what are not facts 
under my observation, nor under the observation of any one 
else of whom I have any knowledge. He says ''It appeal's 
to me, that at the commencement of the attack, there is but 
slight congestion of the mucous membrane of the pharynx." 
In fact at the "commencement of the attack" (there is no 
congestion of the pharynx visible to the naked eye, none, 
whatever.) "Accompanied with slight constitutional distur- 
bance, (The constitutional disturbance is primarily that of an 
ordinary cold, viz a tired feeling, manifested by an inclina- 
tion to lie down, pain in the back, head and extremities, nau- 
sea vomiting and sometimes diarrhoea, dilation of the pupil, 
suffusion of the eyes, and an aqueous discharge from the nose 
before congestion of the pharynx can be observed at all). 
"But in a few hours the membrane puts on a lime appearance 



RATIONAL TREATMENT OF DIPHTHEBITIS . 1)4 

and runs rapidly into a gangrenous? state." I have never 
found such a case though I have been a close observer of this 
disease, and tried to note its ever variable phenomena for the 
past twenty years. Gangrene if ever developed, is not as a 
rule developed in a "few hours after the commencement of 
the attack, 1 ' and in my judgement never occurs, only when 
the case has been mistieated with powerful alkalies. 

He then looks for the severe depression attending this 
change in "meterological causes." If this hypothesis was 
correct, all that would be necessary to cure the disease 

would be to change this "'meterological cause." i. e. change 

© - © 

the atmosphere of the room, and the disease would disap- 
pear. He adds, "Therefore ought we not to look at the 
atmosphere as producing these rapid changes, acting on the 
blood, occasioning the development of the oidium albicans/' 
I think not, look — first at the soil, i. e., the constitution of 
the child, if poor, iilconditioned, anaemic, or if suffering 
from lucocythemia, if the secretions are intensely alkaline, 
then vou have the favorable soil. The growth of any plant 
depends largely on the perfection of the seed, so the viru- 
lanee of disease, depends on these two conditions; the char- 
acter of the soil, and the inherent force of the infecting 
virus, and the atmosphere is but a contingent circumstance, 
favorable, or, unfavorable to its development, as the case 
may be. His treatment is more Rational than his etiology. 
Note "(7." — Dr. Miller, of Michigan, gives it as his 
opinion that this disease has prevailed epidemically and 
"proved very fatal, in localities where no malarial poison 
was known to exist." Parties are generally bitten by rattle 
snakes where none are "known to exist," for had they known 
of their existence there, they would have shuned the place 
and escaped the bite. The bite was however, demonstrative 
evidence of their existence. 

So of Diphtheritis : wherever found, it is the best evidence 
of the existence of its productive cause — malarial virus. 
That is a systoblastic virus, carried by a degenerated or im- 
pure air, and deposited in a genial soil, an inflamed or irri- 



95 RATIONAL TREATMENT OF DIPHTHERITIC. 

tated mueiius membrane, and there fed by an alkaline secre- 
tion. And yet even here, the Doctor could find abundant 
cause for its production, in ''bad drainage, sinks, dampness," 
&c &c. My observation is, that in order to develope the 
Diphtheritic systoblast ; it is not only necessary to have the 
decomposing animal and vegetable virus, but it must be con- 
fined in such a manner as to produce dampness, and when 
thus developed, an increase of dampness in the atmosphere 
is necessary to liberate it, and start it on its mission of death. 
The air arising, unconfined, from such decomposition, may 

produce Enteric fever, but not Diphtheritis. Hence, the 
observation is well put, to look for its productive cause in 
"drains, sinks, cellars" &c, &c. He adds, "Generally in 
the commencement of an epidemic the disease is more severe 
and fatal, and the symptoms more violent, than when the 
epidemic is abating" and the reason for this is evident. In 
the commencement of an epidemic, the patients who are in 
the most favorable condition to recieve the virus are the first 
to recieve it ; and the virus which engenders the disease, is 
that which is first liberated, consequently is the strongest 
or most vital. Hence, we have the two conditions essential 
for the most fatal character of the disease, viz, depleted, 
enervated, illconditioned constitutions. And virulence of 
the blastema on which the disease depends, the maximum 
of force in the incubating virus, and the minimum of resis- 
tive force in the patient attacked, thus per consequence de- 
veloping the most malignant form of the disease. 

"In some cases the patient may become convalescent ; then 
suddenly be taken worse, and in a few hours be a corpse." 

True, but why not give the cause? The autopsies of such 
cases reveals the fact, that after the local lesion has entirely 
disappeared, the oidium albicans have continued their dis- 
tinction of the red blood corpuscles till their vitality is de- 
stroyed, and they fail to supply the system with the essential 
element, of life, and the body fails — the patient dies, unex- 
pectedly, to the surprise of both physician and friends. The 
disease was not cured, its ravages not staid, its local symp- 



RATIONAL TREATMENT OF DIPHTHERITIS. 96 

toms, alone had disappeared, powerful alkalies having facil- 
itated this result, and as unexpectedly done their part i.i 
bringing it about. 

The doctor however aids us in our classification of the dis- 
ease by informing us that the ''exudation spreads over the 
soft palate, nares, fauces, and in some cases extends down 
into the (esophagus and larynx." Thus giving us Laryn- 
geal Diphtheritis and Oesophageal Diphtheritis. A classi- 
fication important, and one to be borne in mind by the Ra- 
tional practitioner. 

As to his treatment, I would reverse it, and give the vin- 
egar internally, and use his chlorate of potass, as a pack out 
side or dispense with it altogether. 

Note. "Z>." — Dr. Bascome's prescription for this disease 
appears to me as a promiscuous jumble of apparent incompat- 
ables without reference to therapeutical value, physiological 
result, or the pathological condition of the patient receiving 
it. If any chemist couid show me why "chlorate of Potass" 
and "acid sulph. aromataci," or quinia and aconite should 
all be blended in one prescription, to meet one pathological 
condition, I should be obliged. I suppose it is administered 
on the presumption, that a shot-gun charged with seven 
buck-shot is more likely to hit the mark than if charged 
with but one. 

If the object is the same, i. e., to kill, I have nothing to 
say; but if it is to cure, I must ask a 7-eason. His external 
application of "fat meat" may answer very well for a black 
eye, but it is not only useless, but is positively injurious in 
Diphtheritic sore throat. As the internal tendency is to pu- 
trefaction, I ask in the name of common sense, what can be 
gained by applying putrefactive elements externally; other 
than to hasten putrefaction? 

Note "E." — Dr. Gross's treatment is perhaps as good 
an illustration of the best general treatment of ten years 
ai>o as can be found. The Doctor is moderate in his reason- 
ing, and as far as possible, Rational in his pathology aiid 
treatment. Baptisia is certainly a very fine antiseptic and 



1)7 RATIONAL TREATMENT OF DIPHTHERITIS. 

aconite or veratrum, are excellent febrifuge-. His paper 
shows careful investigation, and intelligent consideration, 
in the right direction to arrive at important results, if care- 
fully pursued. 

Note "F" — Dr. Gunn, gives us the first invariable, and 
unmistakable symptom of Diphtheritis, which we have found, 
one always present, and peculiar to this disease. ^A sort of 
uneasy sensation, or stinging pain, just inside the throat, op- 
posite the angle of the jaw-bone and under the ecn , as though 
there was some small object lodged there." True, other writ- 
ers have given multitudenous symptoms, but these symptoms 
are frequently characteristic of other diseases; but here is a 
symptom peculiar to the disease, one which is peculiarly diph- 
theritic inits origin and productive cause, and with others, 
points out distinctly the derangement which gives it birth. 
It is invariably present, sometimes slight, sometimes inten- 
sified, and is a characteristic indicator of the malignancy, or 
mildness of the attack, long before this can be prognostica- 
ted from other, attendant circumstances. 

His characteristic which distinguishes it from quinsy is 
important, definite, and infalable. True, as he says "swal- 
lowing in both cases is difficult. In quinsy, the patient 
usually shuts his eyes, leans his head* forward, and swallows 
with a quick, spasmodic effort or jerk ; while in diphtheria 
the face and chin are raised, the eyes stare wide open, and 
the act of swallowing is done as slowly and easily as possi- 
ble, so as appearently to allow the substance to be swallowed 
to pass along the tongue slowly over the epiglotis to the 
oesophagus." That is characteristic, simple and definite. If 
the practitioner has any doubt as to whether it is quinsy, 
or diphtheritis, he has but to present a drink, and observe the 
manner of its imbibition. 

And this distinguishes it also from any ordinary sore throat. 
In any sore throat, other than diphtheritic, there is irritation 
of the throat which causes pain. In diphtheritis there is 
paralysis, or semi-paralysis, of the muscles of the throat, 
which prevents the possibility of rapid deglutition. Again, 



RATIONAL TREATMENT OF D1PHTIIERITIS. 98 

his symptom which distinguishes it from croup is plain, sim- 
ple and easy to be remembered. In croup there is the char- 
acteristic cough, in diphtheritis, in the inception of the dis- 
ease, there is none. 

In Diphtheritic, the nasal passage seems to be stopped, 
and discharge- an aqueous, transparent, irritative, fluid: 
which gives to the voice a sort of nasal sound, not met with 
in croup, quinsy, or any other form of* sore throat. This 
is differential diagnosis, divested of all technicalities, the 
result of close observation and the exercise of common sense. 

Bearing it in mind, any mother of ordinary intelligence, 
need never mistake, the nature of the ailment; and a physi- 
cian can certainly be saved from making confusion worse 
confounded. 

In treatment the Doctor disapproves of emetics, and so 
do I in domestic practice. But if ^een before the third day 
of the disease an emetic mav be given with u'ood results: 

"CD ~ 

hiit not later, and even then, it should always be the acetate 
tinct. of Lobelia. His " Biniodide of Mercury ,'•' being a 
powerful alkali, is not indicated by the physiological action 
of the remedy, or the pathology of the disease ; in fact by 
both is counter-indicated. Ali I can say is that if it would 
cure, in 1879; it will kill, in 1886. There may however, 
be those still, who are willing to experiment with this and 
kindred agents. Such experiments however, had better be 
made on dumb animals and human beings spared the infliction. 

JSTote^G" — .The judicious observation, and cautious, 
strong, g >oJ comm m sense of this author must be my 
apology for introducing this writer, if an apology were nec- 
essary. Whatever irregularities may have attended his ca- 
reer, no living man can accuse him of ignorance. His wri- 
ting will stand as a monument of intelligence as long as the 
American nation shall last, and his well timed, judicious 
medical teachings will bless mankind for untold ages yet to 
come. 

His diagnosis of the case is plain, simple and well defined. 
The "undefined period of incubation," is ever, and always 



i)9 RATIONAL TREATMENT OF DIPHTHERITIS. 

present. Jt may be well marked, or obscure and undefined, 
may pass with out being observed, but is present just the 
same, and if observed, in ninety five eases out of every hun- 
dred, the disease can be aborted by the use of proper re- 
medial agents. The operation of the poison on the blood, 
destroying its fibrin, is well detined ; causing the exudation 
of plastic lymph through the irritated mucous membrane, 
of the fauces, and here producing the false membrane, com- 
posed of fibrin, the result of epithelial change, coming ui- 
rectly from exuded blood-serum, epithelium, degenerated 
blood, mucous and bacteria of the oidium albicans variety. 

His differential from scarlet fever, is short simple and 
clear, and should he borne in mind by every intelligent 
practitioner. 

in his treatment, if seen early, he recommends an emetic 
to relieve the stomach of its putrid, decomposing contents; 
and thus prevent severe febrile reaction, and prevent the 
addition of its morbific contents to an already depleted cir- 
culating medium. 

His "spirit vapor bath,'" needs caution in its use. In fact 
1 should decline to use it, I have seen hot baths used in five 
instances, three of which expired while in the bath and the 
other two died inside of three hours after their removal from 
the bath. The blood being reduced to an aqueous fluid, the 
bath causes a free exudation of this element, and thus redu- 
ces the vital circulating medium, and hastens destructive 
metamorphosis, suspends the hearts action, and induces suf- 
focation, i. e., death. 

His next suggestion is good, and may be used in all cases, 
"a general sponging every three hours with water medicated 
with hydrochloric asid. " By raising the blankets and spong- 
ing the whole body, it lowers the temperature and acts spe- 
cifically, by absorption, on the disease. 

As to a clotty condition of the blood to which reference 
is made, demanding alkaline remedies, such a condition may 
occur, but I have never seen one, even under the most heroic 
acid treatment. In fact the tendencv of the disease is to 



RATIONAL TREATMENT OF DIPHTHERITIS. 100 

the destruction of the fibrim, and thus prevent any thinu: in 
the form of embolism taking place. In my opinion the dis- 
ease would he more effectual in preventing a "clotty condi- 
tion of the blood." than any alkaline remedial agents which 
could be employed. I should take the chances on this in 
preference to supplying pabulum to feed the disease. 

The only case in which I have found alcohol or any of its 
compounds, of any service whatever, is in case of sudden 
colapse ; it being purely an irritative nerve stimulant, there 
can occur in connection with the pathological condition found 
in this disease, no other state, in which it can conceivably 
be indicated. If as Doctor Buchanan has just said ; "The 
diphtheritic poison, when once introduced into the human 
system, has two especial and peculiar affinities, one to the 
nervous system, and the other to the blood;" and its action 
on the "nervous system" is that of an irritative nerve stim- 
lant, as manifested by the febrile reaction and frequent de- 
lirium ; then, in the name of common sense, why add to this 
irritative nerve stimulant alcoholic compounds in the form 
of wine, brandy, &c, &c. Where is the indication, or Re;i- 
son for it? It is not and cannot be found in the patient, only 
in the case supposed, i. e, collapse. Anaemia, requires pure 
air, generous diet, and tonics, but not stimulants. Leuco- 
cythemia requires the same, with iron to augment red-blood 
corpuscles. 

He adds "at the commencement 1 have found inhalations 
of acid vapor excellent." So have I, and equally efficacious 
in the middle, and at the end, though not acetic acid. 

Then we have another paradox. "Diphtheritic patches 
are frequently met with on the mucous membrane of the 
fauces, as a sort of subacute or chronic affection. Unques- 
tionably the best treatment is to paint the part, if within 
reach with nitric acid, then use a gargle of chlorate of po- 
tassse." Use the acid and then the alkali to nutralize it and 
render both inert. Such is the practice of our wisest men. 
"Morphia at night, and alcohol in the morning, being of 



101 RATIONAL TREATMENT OF DIPHTHERITIS. 

presidential prestige, what may we not expect from minor 
names. 

in medicine, as in phylosophy, science and ethics, the 
attempt to be rational, is only of recent date, the mists and 
fogs of a supercilious antiquity are slow to rise, and slower 
still to clear away. The natural tendency of the human 
mind is to cling to the inductions and deductions of the past 
and the only possible, apparent, remedy for this tendency is 
the inherent force of effulgent demonstrated facts, wrought- 
<>ut, maintained and promulgated by men who have sacrific- 
ed their lives, for the elevation of the race ; their only re- 
ward, an honored name, after rolling- ages have convinced 
mankind that they were far in advance of the age in which 
they lived. A forced eulogy, or a marble shaft, is a poor 
return for a life of toil, hardship, self-denial and sacrifice, 
when all (hat could be kindled into life and hope by these 
rememberances, have passed forever beyond their reach, or 
influence. 

Men are compensated to practice what they know, some 
times what thev don't know. Hardlv ever for investigating 
the falsity, or facts of existing theories. 

The age of analysis has arrived; the demand for facts, 
not fancies is upon us, and the man who would breast the 
tide, must be prepared to give a better reason for his acts 
and practices, than the mere repetition of the ipse dixits of 
the past, or present. If he can show no connection between 
the therapeutical, or physiological action of his remedy and 
the pathological condition of his. patient; he must no longer 
feel hurt, if his intellegent patient brands him as a quack, 
or empiric ; even though he may be a graduate of Oxford, 
and parade a parchment from Vienna. 

Rationalism, "a reason for,'* is the imperative demand 
of this practical age in all the phenomina of life. The chil- 
dren no longer rest contented, in the faith of their fathers. 
They may or may not accept this faith as a stepping stone 
to regions still beyond, or they may step beyond without 
this stepping stone, which at best may be but sinking sand. 



RATIONAL TREATMENT OF DIPHTHERITIS. 102 

Hence in the treatment of disease, the physician can no 
longer shake his head, look wise and remain silent ; that age 
and that class of physicians, are rapidly passing away. Anat- 
. omy and physiology in our common schools, is but the in- 
troduction of an higher knowledge of the laws of life, among 
t he common people; and the man, or woman, who would 
command their respect, and secure their patronage, must 
occupy an intellectual plain still above them ; must be able 
to answer the most intelligent question, with an equally in- 
telligent answer, based on sound logic and sustained by good 
common sense. In other words must be rational. This is 
not creating a new school, or originating a new "pathy" 
It is simply classifying the liberal, advanced thinkers and 
actors mail schools. It never asks, "'To what school do you 
belong?" It simply asks "what reason do you give, for your 
belief and practice." It embraces the reasonable, though 
eminating from, and advocated by, the most low and hum- 
ble : and rejects the unreasonable though taught by antiqui- 
ty, promulgated by crowned heads, and enforced by the 
edicts of all the autocrats of Earth. It has in fact become 
the controlling law of physics, philosophy and medicine, and 
is gradually forcing itself into religion. 

That which cannot stand the test of reason, mu>t retire 
into oblivion, before the onward march of human progress. 
God made man a reasoning being, and this being the Alpha 
and Omega of his mundane existence, all that cannot stand 
the test of reason, cannot have e ruinated from the same 
source which he did, hence, must fall below his superior 
power. 

So in medicine, this age demands a reason why, and forces 
medicine into "Rational Medicine,'" "the light of the Pro- 
fession" and I may add the hope of the world. 

Now as to the history of this disease, we have said all 
which we deem necessary. 

As to its cause, I think we have clearly shown that there 
must exist: 

1. A productive cause. 



103 RATIONAL TREATMENT OF DIPHTHERITlS. 

2. A predisposing cause, and — 

3. An exciting cause. 

We have, I think clearly demonstrated that the essential 
productive cause is found in a peculiar virus, on microcosm, 
developed from confined, decomposing animal and vegetable 
matter, that confinement and moisture are two essential con- 
ditions in its production; and that the malignancy, or non- 
malignancy of the virus is largely dependent on the force 
of one or both of these conditions. That an excess of mois- 
ture liberates this virus from its productive cause and throws 
it in the atmosphere which being thus charged becomes — 

3. The exciting cause, carrying it till it comes in contact 
with a patient in which the predisposing cause is well devel- 
oped, and the phenominon diphtheritis is developed. 

Now as to the Predisposing cause. This is a morbific de- 
velopment in the patient himself, in the form, as a rule of 
a common cold, while a strumous, scrofulous, or syphilitic 
diathesis ; or a constitution depleted by previous disease, or 
ill condition by want of care, poor hygiene, &c, all favor 
the developing of the predisposing cause. The moist atmos- 
phere which liberates the blastemia, favors the taking of 
cold, producing the irritation of the fauces, and this forming 
so to speak a favorable recepticle for the deposition of this 
essential systoblast, from thence passing through the mem- 
brane into the circulation, the disease with all its attendant 
train of consequences is developed. 

From this brief etiological review we have the key to — 
THE PATHOLOGY OF THIS DISEASE. 

Pathology as I understand it, is not merely, the doctrine 
of disease. It treats of the morbid phenomina which pro- 
duces it, and the constitutional or functional disturbance 
produced by it — the organic lesion developed, and all the 
attendant phenomina of the entire morbid process. This 
is what I mean by "Pathology." 

Let us then in harmony with this, trace out this morbid 
process from its inception in the human frame, to its remov- 
al from the same. 



RATIONAL TREATMENT OF DIPHTHERITIS. 104 

We have found, not bacteria, not the oidhim albicans, as 
forming the essential systoblast of this disease, but a pecu- 
liar, specific fungi, almost in the form of mould in bread, 
or cheese, yet teaming with animal life forming a lodgment 
in the irritated fauces, increasing that irritation and enlarg- 
ing by contact with an alkaline secretion, passing through 
the mucous membrane into the blood, and there attacking 
at once the red-blood corpuscle, breaking down its fibrin, 
and causing the exudation of plastic lymph, through the 
openings produced by the enterance of the sporules into the 
system. We now have a classified species of microcosms, 
in the circulating fluid, generally called a "specific virus." 
Specifically called the " oidium albicans ," which multiply by 
the million, and setup the destructive metamorphosis char- 
acteristic of the disease. With a miscroseope of five hundred 
diameters, I have counted from one, to fifty, of the micro- 
scosms in a single drop of blood, taken from the great toe 
of a diphtheritic patient — of which a good illustration is here 



given 



Diphtheritic Microcosms. (Magnified,) 

As intimated, these microscosms feed on the red-blood cor- 
puscles, destroy its fibrin, and reduce the blood from a san- 
guineous, to an aqueous element. This direct, destruction 
of the vital part of the blood; accounts for the great physi- 
cal prostration, the depression of the nervous system, and 
the corresponding failure of the appetite, all of which are 
so characteristic of this disease. 

The malignancy, or non-malignancy of the disease depend- 
ing as previously intimated, on the force of the affecting 
virus ; the favorable condition of the patient, as a predis- 
ing cause, and finally on the treatment adopted. As it must 
be self evident that if the proper pabulum is supplied to the 
patient, in the form of medicine, to feed and fatten these 
microscosms, just in proportion as they gain strength, the 



105 RATIONAL TREATMENT OF DirHTHERITlS. 

patient must loose it; and as they multiply and triumph, the 
patient fails and dies. Hence, we have nature, again, ma- 
king as a rule, a spasmodic effort to remove this poison, in 
the form of intermittent febrile reaction. During the ac- 
tivities of the dav the system has become so much irritated 
by the distinctive metamorphosis going on within, that by 
seven, eight or ten o'clock, as a rule active fever sets in, 
generally lasts till four, tive or six o'clock in the morning; 
to be repeated next night in an augmented degree, if the 
disease is allowed to progress. This febrile reaction should 
not be mistaken as an cssen ial part of the disease. It is 
nature making an effort to remove a morbid cause. The 
vis. a tergo of nature asserting itself, rousing up to repelant 
action — please don't cure the fever, by killing the patient 
in doing it — rather help it to remove the morbid cause, by 
curing the disease, and save the patient. 

When ever a mucous membrane is tinned, or excessively 
porous, here an exudation of plastic lymph may take place, 
and false membrane form. There is nothing mysterous 
about it, it is simply a natural process, arising out of a dis- 
eased, depleted, or porous membrane, through which a lymph 
created by distruction of blood dies exudes, collects, and 
forms in a tough tenacious mass, if this mass is forceblv ie- 
moved, the exudation continues, acd the process of forma- 
tion is repeated, and this may occur on any mucous mem- 
brane of the body. In fact this destructive metamorphosis 
in the blood is such, that in any abrasion, in any part of the 
body, where blood would naturally exude, this plastic lymph, 
composed of epithelium, fibrine, degenerated blood, micro- 
cocci and serum, may take place. I have seen it in the corn- 
er of the eye, in a scratch on the cheek, back of the hand, 
&c. &c. 

Now if this pathology is correct, the simple question is, 
what does it point to as a— 

EATIONAL TREATMENT. 

I. Prevent a child from taking cold, and thus remove the 



RATIONAL TREATMENT OF DIPHTHERITIS. 106 

predisposing cause. This is much more simple than most 
people suppose. Habituate children to neither eat nor drink 
anything hotter than 98° Fab. and give a cold sponge bath 
at least twice a week and rub the whole body well with a 
tlesh brush or coarse towel, and thus fortify the system 
against climatic changes. Then guard against extreme heat 
as well as cold. It is a well known fact in medical science 
that there is no such thing as taking cold, strickly speaking. 
We take a heat, and the cold takes us; hence, prevent the 
excess of heat, and fortify the system against cold, and thus 
prevent the formation of a genial soil for the incubation of 
the disease. But if the child has taken cold, then — 

II. Use every possible abortive measure. Break up the 
cold, and if the child begins to complain of being tired, wants 
to lie down, complains of pain in the back, limbs, back of the 
neck, head, declines to eat, is nauseated, or vomits, has a 
watery discharge from the nose, the pupil of the eye dilated, 
or the fauces begin to look red and inflamed, fever at night, 
feels as though there was a splinter in the back part of the 
throat; do not wait for all these symptoms to appear in any, 
or every individual case, but as two or three of them appear 
commence abortive treatment. 

Give an emetic of acetate tine, of lobelia, teaspoonf ul doses 
to a child two years old every ten minutes till free emesis 
is produced. Keep the child in bed or in a warm room, tem- 
perature from 60° to 70° Fah. and give it all the cold water 
it wants to drink, making it acid with cream of tarter, lemon 
juice, or common vinegar, if the other acids cannot be ob- 
tained. Remember this disease incubates only in alkaline 
secretions. Hence, if you can change the secretions of the 
mouth to un acid condition, you render incubation an im- 
possibility. 

In case of this disease becoming epidemic, or children, or 
adults being exposed, place two ounces of Bi. tart., Patass, 
or cream of tartar in a pint of water, and take a tablespoon- 
ful three times a day, and I would insure a wdiole commu- 
nity against the ravages of this disease. Is it not passing 



107 RATIONAL TREATMENT OF DIPHTHE RITES'. 

strange that medical men should have observed, that as chil- 
dren pass from infancy to more mature years, and the se- 
cretions of the mouth, become more acid, it becomes a pro- 
tection against this disease, and yet it should never occur to 
them to change the secretions to an acid condition as a com- 
piete protection against its encroachments? It is strange, 
and yet such are the facts in the case. A blind adherence 
to an alkaline treatment, must be the only excuse for such 
inattention to simple physiological, indicative facts. 

If inflammation of the fauces is observable in the slightest 
degree ; then eommence at once with the acid remedy under 
treatment farther on. 

III. The disease now being fully recognized, perhaps when 
too late to abort, or perhaps not sean till too late, then I 
invariably commence, continue and end with the following: 

R Sulph. acid dil ^ ij ; 

Tinct. phytolacca _ ^ j; 

Tinct. sanguinaria 3 ss; 

Tinct. capsi 3 j; 

Aqua cassia ^ viij. Mix. 

Signa. — Give half a teaspoonful once an hour, or once in 
two hours, according to circumstances. 

Let us now analyze this, and find the true physiological 
and therapeutical action, of these individual remedies; and 
then examine these in the light of our pathological revelations. 

Sulphuric acid acts especially upon the great nervous cen- 
tres, the ganglonic system, and especially upon that portion 
which presides over the function of nutrition, rousing these 
up to action when dormant, and stimulating them when at 
deep rest. Now in this disease our pathology reveals the fact, 
that the functions of digestion and nutrition are not only dis- 
turbed but often entirely suspended, thus calling distinctly 
for some agent calculated to sustain their integrity, till mor- 
bid action is suspended. Hence, I know of no remedy in 
the Materia Medica, which so completely meets the indica- 
tions produced by this disease as sulphuric acid. The pro- 
fession have lomr used it in cases of much debilitv with a 



RATIONAL TREATMENT OF DIPHTHEIilTIS. 108 

sensation of tremor all over the body, with trembling, loss 
of appetite, &e, &c, with ecchyinosis, the very condition 
indicated, or found to exist in this disease. 

But in addition, it is the only chemical reagent known, 
which positively, and invariably, destroys the microcosms. 
Oidiuia albicans in the human system. This discovery I 
made some forty years ago. The first case of diphtheritis 
I ever met. I obtained a piece of the false membrane, ex- 
amined it under the microscope, found the microcosms and 
tested various chemical agents for their destruction. I found 
they grew T and multiplied rapidly in a 95 per cent, solution 
of potassa. While sulphuric acid secured their immediate de- 
struction. 1 then commenced a reductien of the acid and 
found it still effectual, much weaker than ordinary diluted 
sulphuric acid. These facts being published formed the basis 
for Dr. Greatheads, supposed discovery in Hamilton, South 
Australia; on which he obtained eight thousand pounds ster- 
ling, (near $40,000.) 

i have tested this formula in 973 'cases in this state in the 
past ten years with uniform success, and hence, know of 
what I write The destruction of these microcosms being 
the prime factor in curing this disease, the other agents are 
incidental, to meet other urgent indications. Irritation of the 
fauces exist, general prostration supervenes ; hence, we 
need a stimulant (not alcohol,) we need an agent to restore 
healthy circulation to the seat of the lesion. Let us see 
how we can accomplish this. 

The physiological action of Phytolacca is through the gan- 
glome system, it affects the glandular system, and especially 
the glands of the neck, and the upper portion of the ali- 
mentary canal, particularly the mucous membrane. 

In this disease our pathology reveals severe glandular 
swelling:, with excessive inflammation of the mucous inem- 
brane of the upper portion of the alimentary canal. Hence if 
we found such a condition existing independent of this pe- 
culiar disease, we would regard this remedy as just the thing 
we needed. So in this disease, it promptly reduces the swol- 



109 RATIONAL TREATMENT OF DIPHTHERITIS. 

len glands of the throat, allays the inflammation of the mu- 
cous membrane, hence, we combine it in our formula, as 
therapeutically and physiologically calculated to remove this 
morbid phenominon in this disease ; which it effectually does. 
Dr. Burt states, "1 can now repeat, that it is still the bent 
knoivn remedy, for diphtheria, when the air passages are 
not involved." But as the air passages are nearly always 
more or less involved, especially the mucous membrane of 
these passages and mucous membrane of the lungs, we need 
a remedy having a special affinity for these; and this rem- 
edy we find in, sanguinaria, which is declared to "act es- 
pecially on the mucous membrane of the air passages and 
the lungs," and " slightly on the motor and sentient nerv- 
ous system." These it stimulates and hence prevents motor 
paralysis, which is complained of as such an obstinate se- 
quela of diphtheritis. We use it in the rusty-colored sputa 
of pneumonia, when the breath and sputa smell bad, even to 
the patient ; or when we find raised patches on an inflamed 
mucous membrane. And as these charactertics are generally 
more or less promptly present in this disease, we combine 
it in our formula, and find it meets those indications in the 
most happy manner. 

Capsicum. As in our pathology we find frequent capill- 
ary congestion, arising out of broken down fibrin, we want 
a remedy to act directly on those capillaries. We have seen 
that through an impoverishment of the blood, there was ex- 
cessive nervous prostration to overcome; for which the 
great mass of practitioners use alcohol, or some of its com- 
pounds. This being exclusively an irritative nerve stimulant, 
its secondary effects can only be to add to that depression; 
as stimulating the system up to, or above the normal stand- 
ard, its reaction must be correspondingly, an augmented 
depression. This with capsicum is not and cannot be the 
case. It stimulates the mucous tissue, and induces a freer 
circulation of blood to the parts. It stimulates the stomach 
and induces freer peristaltic action, and thus gives tone to 
that organ, increasing the demand for aliment, and thus sus- 



RATIONAL TREATMENT OF DIPHTHERITIC, 110 

taining the sinking frame, and enabling nature to resist de- 
structive metamorphosis. "Its extraordinary power to con- 
tract the capillary circulation, to bring excess of blood, and 
thence scatter more than it brings, enables it to remove con- 
gestion, to reduce swelling as promptly and effectually as 
belladonna." (Marcy and Hunt.) 

We have a tendency to capillary congestion, capsicum re- 
moves it. We have obstinate swelling of the glands of the 
neck, capsicum reduces it; we have depleted mucous mem- 
brane, capsicum stimulates it to a healthy action, we have 
intensified nervous depression, capsicum overcomes it by in- 
ducing a freer circulation to nerve centres. No remedy in 
the materia medica of any school, will as promptly reach 
congestion of a mucous membrane as capsicum. Hence on 
account of its direct physiological action, and important ther- 
apeutical properties, we have combined it in our formula ; and 
with results, without a parallel in the history of this disease. 

We have thus examined carefully and candidly the known 
drug action of each of these elements; we have examined 
them in their relation to the pathological condition present- 
ed by this morbid process: and we H \d their therapeutical 
action to be just what is needed to combat and overcome, 
each distinctive pathological manifestation, and thus cure 
the disease. 

If any doctor, living or dead, on this Continent or any 
other; of any medical scheol on Earth, or in Heaven ; will 
present us with a formula, each element of which is better 
adapted to meet those isolated indications and cure the dis- 
ease as a totality; one that evinces a stronger claim to Ra- 
tionalism than this; and is sustained by 3 7 ears of practice, 
special application, and upheld by thousands of living patients 
snatched from the grave by its use ; in the name of all that 
is good and great, pure and holy, and for the sake of suffer- 
ing humanity, let it be known, and thus aid in ending specu- 
lative, paradoxical, empirical practice; aid in making us more 
Hational. Till this, we must be excused, if we act on 
Buttlers maxim; "If a fact is well established, objections 



Ill RATIONAL TREATMENT OF DIPHTHERITIS. 

to it, amount t<> nothing, as the objection is founded in our 
ignorance, and the fact is sustained by our intelligence."' 
Though we are well convinced that this one formula wil! 
cure ninety five per cent of nil curable cases : it does not. 
embody all our praetce in this disease. The only diet which 
we have deemed it advisable to restrict is sweet milk, as the 
acid is known to produce a dry hard coagulum, which in the 
generally depressed condition of the stomach, it is found 
hard for that organ to reduce to chyme. Hence, its nutri- 
tive properties would be largely suspended. It would thus 
act as a foreign, irritative substance, and be detrimental 
instead of beneficial. 

Besides acid drinks and an wholesome, nutritious, gener- 
ous diet, easy of digestion, in severe cases, I use a spong 
bath twice a day, morning and evening, of nitro muriatic 
acid : one drachm to half a pint of water ; sponging the whole 
body well and carefully and not wiping it, but leaving as 
much of the acid as possible to be absorbed. My reasons 
for this are: 

1. It opens the pores of the skin and allows morbid accu- 
mulations to pass off. 

2. It thus cools the patient, by assisting nature to throw 
off effete matter, and thus accomplishes the work attempted 
by febrile reaction, and thus prevents fever. 

3. The nitric acid acts especially on the mucous outlets 
of the body, and especially where the mucous membrane 
merges into the skin, the glandular svstem and the blood. 
While the muriatic acid effects especially that part of the 
eranglonie nervous svstem which presides over the g&sfro- 
intestinal canal, sustaining these for renewed action in the 
removal of this disease. 

Hence these baths thus formed, are an important auxili- 
ary in combating this morbid process. 

After the conflicting views which we have just seen re- 
specting topical applications to the neck, the most intelligent 
practitioner may well hesitate in their use. One high in 
authority denounces them altogether. Another recommends 



RATIONAL TREATMENT OF DIPHTHERITIS. 112 

"fat meat; another "salt and vinegar;" another "alcohol;" 
which I must assume the prescriber would rather have rubed 
oil the inside of his own neck, than oil the outside of his pa- 
tient's; and thus there is nothing uniform, systematic or ra- 
tional. 

Let us again turn lo our pathology and find the state of 
the organs and there get the key to what needs to be done. 
We find the glands of the neck intensely swollen and hard, 
forcing I he head back wards, and somtimes forcing the ton- 
gue to protrude out of the mouth, while the inside is covered 
with this plastic lymph which forms this false membrane, 
and with this membrane from the peculiarity of its compo- 
sition prevents the absorption of remedies for its removal. 

Now this turgesence of the throat produces intense heat 
and augments the patients suffering. Alcohol will increase 
that heat and thus augment the discomfort. Fat meat will 
do the same, hence, both are worse than useless. We need 
something cooling, yet calculated to remove the severe con- 
gestion, and act by reflex absorption on the mucous mem- 
brane, and stimulate it to throw off this accumulated plastic 
lymph. 

Potass Nitiasis well known to possess these (tooling prop- 
erties in a larore decree, and acts as an excellent solvent in 
all glandular swellings. The^e >olvent cooling properties 
are materially increased by the addition of muriate of am- 
monia and camphor; and camphor is one of the few reme- 
dial agents which will remove and prevent, the exudation 
of this plastic lymph if applied to the mucous membrane. 
Hence, from the condition of our patient, and the therapeu- 
tical aclion of these remedies we deduce the follow ng 
formula for external application. 

R Potass nitras 3 j ; 

Ammonia mur. 3 ss ; 

Spts. camphor 3 ij ; 

Aqua q. s. f. 513. M. 

Sig. — Saturate a cloth and keep it wet, bind around the 



113 RATIONAL TREATMENT OF DIPH'i HERITIS. 

head so as to keep the saturated cloth well up to the angles 
of the jaw. 

Binding a cloth simply round the neck is worse than use- 
less. The disease is not down on the neck, but up right un- 
der the niaxilarv. To hold anything there it needs to be 
bound under the jaw and over the crown of the head. Using 
this don't be surprised to find the comfort induced is such 
that as soon as the cloth begins to get dry your little patient 
crys to have it wet again, or, that in twenty four hours the 
camphor is doing its work, in removing the exudate from 
the fauces. This is the only external application I have used 
for years, and I only use it, if the glands become swollen 
and hard. 

THE FEVEK. 

My experience is that this is almost invariably of an inter- 
mittent type. Though writers on this disease have either 
failed to recognize the fact, or failed to record the same. 

This is a malarial form of fever prevalent in all countries 
where the temperature of atmosphere exceeds 75° or 80° . 
Its productive cause is, decomposing vegetable matter acted 
on by solar heat, operating on a predisposed patient. Thus 
the same cause which operates to produce the Diphtheritic 
virus, operates at the same time to produce the malarial vi- 
rus which developes this peculiar type of intermittent fever. 
The fever, being natures effort, in this case, to expel the 
two-fold virus. Now what is needed, is something to over- 
come the virus, not to cure the fever, the fever don't need 
curing; it is the virus that needs removing, and the fever 
will stop of itself. 

Now the congestion produced by this malarial virus, as a 
rule cannot be combated and overcome by aconite, or vera- 
trum ; both of these act therapeutically in all congestions 
tending to inflammation. This congestion does not tend to 
inflammation, therefore these two remedies are not indicated 
in this class of fever. In many years practice I have never 
found but two cases of fever accompanying this disease which 
demanded aconite, or veratrum and these were purely idio- 



RATIONAL TREATMENT OF DIPHTHERITIS. 114 

pathic, instead of symptomatic. Aconite and veratruni are 
the remedies in idiopathic fevers. But this fever is not gen- 
erally idiopathic. Therefore aconite and veratruni are not 
indicated. 

In ail symptomatic fevers gelseminum sempervirens is 
the remedy which our pathology demands, and which its 
physiological and therapeutical action indicates. Hence for 
this type of fever I invariably use the following: 

B Tinet. Gelseminum Z ij \ 

Aqua menth. pip. 3 ij. M. 

Sig. — Give a teaspoonfnl once an hour, two, three, or 
four hours, according to circumstances. In case the fever 
runs very high, I give half the quantity in half the time. I 
have thus had occasion to give it as often as every ten:. min- 
utes ; till the fevet begins to decline, then at longer intervals; 
till the malarial virus is overcome, and the fever ceases. 
Should the inflammation of the fauces be such as to create 
an idiopathic fever, we would then use aconite, or veratruni 
according to indications. 

This disease should be distinctly classified, and the dan- 
gers incidental to its location throughly understood, and 
distinctly announced to interested friends ; this would often 
prevent after reflections on a faithful physician who had done 
his best to overcome the disease. Our medical literature, 
has so far formed no classification, it simply calls it "Diph- 
theria," and there it ends. "A membrane," without loca- 
tion, inflammation, or other marked action. .What ails your 
child? Oh! it has got Diphtheria, i. e., "JL membraneW" 
That is inflammation certainly!] who does not know the 
child has got a membrane, but what of that? It requires 
other terms to designate and locate the disease. 

We have six distinct locations of this disease, and the 
uauger to the patient, is augmented just in proportion to 
the location of the disease. We have as a consequence. 

1. Fauceal Diphtheritis. 

2. Laryngeal Diphtheritis. 

3. Pharyngeal Diphtheritis. 



115 RATIONAL TREATMENT OF DIPHTHERITIS. 

4 . (Esophageal Diph th eritis . 

5. Bronchial Diphtheritic. 

6. Nasal Diphtheritis. 

1 . Fauceal Diphtheritis, is the most common form. It is in 
fact the central starting point of all the rest. If the exudate 
remains there, it is then simple Fauceal diphtheritis, pro- 
ducing less pathological metamorphosis, less nervous de- 
pression, less febrile reaction; is simply a mild form of the 
disease from which the patient under good care and good 
treatment may recover in from four to ten days. 

2. Laryngeal Diphtheritis, this extends beyond the fau- 
ces proper, and involves the larynx, the palate, and roof of 
the mouth. The exudation is more abundant, because of 
the greater surface involved, the glands of the throat are 
more swollen, the prostration is greater, deglutition is more 
difficult, the fever is higher. It is simply a severer type of 
the mildest form, in which it may assume a croupous form 
and affect the organs of speech. The danger to the patient 
is just in proportion to the organs, and tissue involved, and 
if this fact had been carefully noted, and friends distinctly 
informed of this fact, much blame and eenture would have 
been spared. 

3. Pharyngeal diphtheritis, is an extension of the dis- 
ease to the pharynx, involving the organs, especially of res- 
piration, and is indicated at once by the laboured manner 
in which this function is performed. The danger to the pa- 
tient in this case, arises from two sources. 

1. The inflammatory process may become such as to form 
occlusion of the wind-pipe, and the patient die, asphyxia. 
Or, 2. The exudation of plastic lymph may be so great in 
this region, as to form the occlusion, and thus suffocation 
may take place. 

4. Nasal Diphtheritis, when the inflammatory process 
involves the nares or the nasal passage, and an excessive ex- 
udation takes place along its mucous membrane, obstructing 
the nose, and creating an extensive ichorous discharge which 
creates ulceration of the entire nasal fossa. This class is 



KATIONAL TREATMENT OF DIPHTHERITIS. 116 

dangerous from the proximity of the lession to the brain, 
to which organ the inflamatory process may easily extend. 
Some twelve years ago, I saw a physician (1 suppose 1 must 
call him such), after cauterizing the fauces with lunar caus- 
tic, pass a feather through both nostrils to the mouth, the 
child passed rapidly into convulsions and in two hours after 
was a corpse. Nearly every writer quoted cautions against 
removing the membrane by force. This caution holds good 
especially in this class of this disease. 

Some years ago Dr. Buckland, of this state gave me the 
following to be used with a spray injector, or inhaled in the 
nose before the nasal passage became occluded, and recom- 
mended its trial in those cases. 

R Bromine, 3 ss ; 

Sul. i ither, 3j; 

Tinct. iodine, gutts. xv. M. 

Sig. — Inhale or use a spray injector. I first wash the nose 
out carefully with warm water, sweet milk and a few drops 
of spirits of camphor, and then use the above, by inhalation 
if the patient can -till inhale, but by the spray injector, if 
not. In fact 1 prefer the latter to the former. I find that this 
gives prompt relief, producing a free discharge, and healing 
the irritated surface. If promptly and intelligently attend- 
ed to this (.-lass can easily be reduced to the simplest form, 
Fauceal Diphtheritis. But if not, it will soon pass to an un- 
certain, if not promptly a fatal stage. 

5. (Esophageal Diphtheritis, I regard this as the most 
fatal of all varieties, producing comparative, if not positive 
occlusion of the CEsophagus, rendering swallowing difficult 
if not impossible. Physicians have not been sufficiently 
careful in their differential diagnosis, and have frequently 
performed tracheotomy, when the obstruction was in the 
CEsophagus instead of the wind-pipe. It is needless to add 
such a mistake is always fatal. I have succeeded once by 
using an injection, per rectum of the acetate Tinct. of Lo- 
belia, in relaxing the system, producing emesis, and forcing 
the coagulated lymph creating the obstruction out of the 



117 RATIONAL TREATMENT OF DIPHTHER1TIS. 

mouth, in the form of a perfect east of the CEsophagus, and 
once was called too late to wait for the action of the lobelia ; 
I In podermically injected apo-morphia over the pylorus, 
produced prompl ernes'^, forced out the obstructing cast, 
and took my patient out of the very jaws of death. He still 
lives to bless his family, being at the time a man forty two 
years of age. These are the only two cases which 1 have 
had of this class of disease, and from the results thus ob- 
tained, 1 should not hesitate to persue the same method if 
called again in a similar case. 

6. Bronchial Diphlheritis , in this class the inflamatory 
process passes to the bronchia and bronchi, through the in- 
flamed mucous membrane of these organs this plastic lymph 
exudes, coagulates or forms the charaeteristic false mem- 
brane, this enlarges by continuous exudation till the occlu- 
sion, partial or absolute, takes place and death ends the scene. 

Sometimes the irritation produced developes a peculiar 
spasmotic cough. This cough like the fever is natures ef- 
fort to cure by removing the obstruction. In such a case 
no sedative should be given, but here in case of collapse 
alcoholic stimulants may be used ; anything, everything to 
sustain the patients strength, till this effort of nature secures 
relief, by coughing up the obstruction. It is in thrse cases 
that tracheotomy has been peformed, and at no time has 
been a success. The incission in the wind-pipe and the in- 
sertion of a tube neither removes the obstruction, prevents 
the exudation, or benefits the diseased patient, as far as the 
removal of morbific influences, or the cure of the disease is 
concerued. 

If seen in time, say before the third day, any or all of 
those complicated extensions of the morbid process may be 
prevented, it remains simple uncomplicated diphtheritis, 
with no adverse attendant sequelae, leaving a patient bed- 
ridden for months, or to end his suffering by sinking to the 
grave. At least this has been my experience in this state 
in 987 cases treated in the past eleven years. 

But we have another class of patients to treat. Infants 



RATIONAL TREATMENT OF DIPHTHERITIS. 118 

at I he mothers breast, whose life depends on milk, io whom 
I never give this acid solution, and who cannot bear acids o: 
any kind. In such eases I am uncertain, careful, but nevei 
confident. I rely on the acid sponge bath, and a weak so- 
lution of bichromate of Potass, say one grain to four ounces 
of water, of which I generally give from ten to twenty drops 
once an hour, once in two hours, seldomer, or oftener, as 
the case' may demand. 

I have not written respecting that class of patients, hence 
shall leave them for every practitioner to use li is own judg- 
ment, and; persue his own method. I have never used the 
arid treatment where milk could not be intradicted. It 
might not be injurious, but never having investigated the 
matter I could not tell. If others see tit to experiment with 
this treatment they can do so by taking the responsibility 
of their own acts. 

THE ERUPTION. 

Not unfrequently this disease is accompanied by an erup- 
tion on the skin, sometimes resembling scarlet fever, at other 
times it may resemble measles, and still at other times I 
have seen it resemble small pox. The variation in the erup- 
tion is caused by the different temperaments of the patients. 
In a blond the rash is fine and resembles scarlet fever, in 
the semi-blond ir may resemble scarlet fever, or measles 
In the very dark brunette it may assume the form of a pret 
1y severe ease of confluent small pox. Thus in the nervous 
temperament we have the fine msh in thesanguin nervous the 
coarser, and in the billions temperament, we have the seVerei 
■ ype; any of which I regard as a favorable indication rathei 
than otherwise. It is nature throwing off morbid matter, 
through the pores of the skin, and is invariably the result 
of excessive alkaline secretion, for as a rule as soon as these 
,secrtions are changed to an acid, this eruption disappear^. 
The acid bath generally gives prompt relief. Should it re- 
main, I have found a weak solution of belladonna .jr-ve the 
best results. 



119 RATIONAL TREATMENT OF DIPHTHER1TIS. 

PARALYSIS. 

This is a complication I have never met with, succeeding 
the acid treatment, so I am inclined to look Upon it, as, more 
frequently the result of improper medication than a conse- 
quent of the disease. 

But when found to exist the practitioner seldomly asks 
what caused it? but may often have to ask "how may I get 
rid of it?" This is a question easier asked than answered. 
If we could trace out the exact cause of the paralysis it would 
be easy to suggest the remedy. 

All the cases which have come under my observation were 
motor paralysis, not sentient, and from a careful inspection 
of these cases 1 concluded they arose from the impoverish- 
ment of the blood, it thus failing to supply motor force to 
the ganglia, or motor nerve filament, and this conclusion ap- 
peared justified by the fact, that as the circulating fluid grad- 
ually became normal, the paralysis as gradually disappeared. 
If this conclusion is correct, then the proper treatment 
would be largely to let the paralysis alone, and restore the 
blood to the normal standard. 

I have found electricity an important adjunct to the in- 
ternal treatment. Should it arise from an embolis pressing 
on the nerve filaments, after the real disease has disappear- 
ed, then an alkali may be administered; but in view of the 
fibrin in the blood being as extensively broken down, or de- 
stroyed. My convictions are that this condition rarely exists. 
It generally can only arise from a highly fibrinized condition 
of the blood, and we have seen that this condition is not 
likely to occur in this disease. In this condition there is a 
strong tendency of the blood to clot on the walls of the ves- 
sels, the interior of the heart, in fact no part of the body 
appears to be exempt from this tendency, as this fibrinized 
coagula may be carried forward by the circulation, and block, 
or close up any particular vessel, or vein ; these coagula be- 
ing arrested generally in their peripheries. Where this con- 
dition has been a cause of death, post mortem examinations 
have revealed fibrinized patches on the walls of the vessels, 



RATIONAL TREATMENT OF DIPHTHERITIS. 120 

with large coagula in, the heart, liver, lungs, or brain of the 
subject. The diagnosis of this condition is very obscure, 
and consequently equally uncertain. It is a well known fact 
that whenever a substance much larger than a blood-cell en- 
ters the circulation it is swe^t jji award by the .current till it 
reaches a vessel, through which it is unable to pa>s : it then 
becomes wedged into its new position. Of course this acci- 
dent is most likely to occur in that part of the va>cuiar sys- 
tem, which this coagula has first to travel after its detach- 
ment.. As a consequence the vessels of the brain are most 
a[)t t > be obstructed in disease of the heart, and more, or 
less functional derangement of this organ is always present 
in this disease. The first result of an obst -action such as we 
have described, would be the loss of functional power in the 
parts thus deprived of their nutriment. It is thus that par- 
alysis takes pla.de when any portion of the brain is gradually 
or suddenly rendered anaemic. If the circulation is restored 
,by the blood finding its way through colateral branches, no 
permanent injury is produced, but if this is not the case the 
vessels greatly enlarge and hemorrhage rakes place. Now, 
I have never found such hemorrhage in connection with 
Diphtheritic paralysis; though I have had one case in which' 
paralysis presisted for two years after, every other symptom 
of the Diphtheritis had disappeared. Hence, I conclude that 
Diphtheriiic paralvsis does not generally arise from an em- 
bolus, but from an impoverishment of the blood, and it, thus 
failing to supply proper nutriment to motor ganglia, or par- 
ticular nerve filament. And if so, it can only be overcome 
by enriching the blood, and judiciously using electricity to 
the paralyzed part, and ihus establishing an healthy circu- 
lation. If however, an embolus should be, positive]}', found 
to exist, then the sequi-carbonate of ammonia is an alkaline 
agent which, while it possesses all. the essential properties 
of all other alkaline agents, possesses the additional proper- 
ty of exciting the heart to more vigoious action, and thus 
impelling the circulation with accelerated force through the 
system ; this agent well diluted should be freely administered. 



121 RATIONAL TREATMENT OF DIPHTHERITIS. 

If the coagulum is supposed to consist of a deposit of fibrine 
Bromide of Ammonia, is m very excellent remedy. Sulphite 
of Soda is good in tedious convalescence. Potass Perman- 
ganate has a like effect. Quinine may he used for its tonic 
effect in the absence of Scutilaria, or Cocoa. Such is the 
treatment which I have pursued for years, varied, changed, 
modified to meet individual idiosyeraeies, or contingent sur- 
roundings; hut never changed in its, essential features ; not 
it is true with uniform success, hut with a success far in ad- 
vance of all other methods, of which J have any knowledge. 

There are two facts which the profession should ever keep 
prominantly before the public, viz. 

1st. That Diphtheritis, in all its varied forms and combi- 
nations, under the best circumstances and hygienic surround- 
ings is a very dangerous disease. 

2nd. That there are numerous cases, which, with the best 
: urroundings and the most advanced treatment, will prove 
fatal, in opposition to the best effort which can possibly 
be made, and this fatality may arise from mulitudenous 
causes over which neither friends nor physicians can have 
any control. 

There is: 1st. The virulent nature of the effecting virus. 
That this virus, cannot in all cases be of a uniform chemical 
strength, is a proposition admitting of no discussion. That 
the sporules which constitute the blastemia, of the produc- 
tive cause of this disease, are not all of the same grade of 
vitality, will be readily admitted by all who give the matter 
a moments throught, and that this vitality may equally mod- 
ify the disease produced by them, must be equally evident. 

Thus an high grade of vitalitv in the effecting virus, is 
certain to augment the malignancy of the disease produced, 
and vice versa. Just the same as the bite of the Taiantula, 
is more venomous, than the bite of the common spider, or, 
the sting of the wasp, is more painful and malignant than 
the sting of the mosquito. So with the infecting virus of 
this disease. The decomposing vegetable and animal mat- 
ter which developes it, may have been confined for a long 



NATIONAL TREATMENT OF D1PHTHERITIS. 122 

time, or combined in such quantities, as to render its product 
peculiarly malignant from its first inception in the human 
system. Their product, partakes of the vitality of their 
parentage; tiiey multiply more rapidly, and consume a larg- 
. er amount of the red-blood corpuscles in a given time, break- 
ing down the strength of the strongest patient with amaz- 
ing rapidity, and carrying them off, before friend-, or phy- 
sicians have time to truly diagnose the case. 

Then there is: — 2nd. The extent of the abraded surface 
which forms a lodgment for these fomites. 

If the patient has h;id a common cold for sometime, ac- 
companied by a severe cough producing a larger irritated 
surface; a larger amount of the fomites will thus be retain- 
ed on this irritated surface, and the disease produced may 
be correspondingly malignant, rendered so by the amount 
of the virus reeeived. This is a principle universally recog- 
nized in all natural, or morbid phenomenon : but hitherto, 
has been neglected, or overlooked in connection w.lh the 
estimates of the maliiniancv of this disease. 

A small amount of arsenic may act as a tonic, a larger 
amount may produce death. 

A small amount of aconite will allay inflammatory fever, 
a larger amount will set up destructive metamorphosis and 
kill the patient. 

So, a lanre amount of the Diphtheritic, infecting virus, 
passed into the human system at one time, musthave agreater 
tendency to break down at once the resisting forces of the 
patient, and increase the destructive na! ure of the morbid 
process. Const quently, the extent ofthi> irritated surface, 
must modify the malignancy of the attack, rendering many 
cases fatal which might have been saved hid the irritated 
surface been less; but its extent may be such as to render a 
case exceedingly hopeless from the first. 

Then again: — 3rd. The physical condition of the patient 
ma; he such, that the incubation ot the disease mav be but 
the precursor of rapidly approaching desolution. 

And this may be the case, even without constitutional 



123 RATIONAL TKEATME^T OF DIPHTIlERI.'l IS. 

taint; but with it, the changes for a fatal .termination of 
(purse are multiplied. 

A very healthy, fleshy child, with a thick short neck and 
large glandular system* is a subject for this disease. The 
shortness of the neck, and the largeness of the glands, arc* 
not calculated to admit of much inflammatory action; hence 
if the case becomes at all malignant, the patient is almost 
cert-aiu to die from asphyxia, or, suffocation; the inflamed 
glands producing occlusion of the air passages. 

Then we have the constitutionally anaemic patient, of con- 
sumptive, scrofulous, or syphilitic origin ; whose blood is 
constitutionally tainted, thus weakening all their resistive 
powers, and impairing their hold on life, when attacked 
with any disease. 

They largely form our malignant and often hopeless cases 
in all epidemic diseases. If they have measles it is mnlig- 
nant ; if they have scarlet fever, it is malignant ; small-pox, 
it is confluent, or diphtheritis, it is often fatal. And if pa- 
rents were well informed of these facts, their judgement of 
the honest, faithful, conscientious physician would be ma- 
terially modified. 

If they, by their own acts, have planted the seeds of early 
death in their offspring, they certainly should be slow to 
place the responsibility of an early harvesting, on other hands. 
In an acute attack, of a malignant disease, is a poor time to 
expect a physician to overcome the disease, and remove 
from the system, the morbid blastemia planted by parental 
ignorance, or indiscretion : which was of itself, at least, the 
precursor of an early desolution. 

Then we have: — 4th. And lastlv. Individual surround- 
ings, which not unfrequently, render the best conducted 
measures for restoration abortive, chief among which, are. 
cold rooms, pool clothing, defective nourishment, bad nours- 
inff and unwarrantable interference. All, or any one of 
which may jepardize the life of the patient, and defeat the 
most scientifically conducted therapeutics. It should be 
distinctly understood by parents, guardians and nurses, that 



HYGIENE AND NLKSING IN D1PHTHERITIS. 124 

in this disease, above all others; every facility must be pro- 
vided, every auxiliary which will aid the physician must be 
utilized, and every direction must be most minutely follow- 
ed ; if its fatality would be prevented, and perhaps an epi- 
demic des roved In its inception, and not only a patient, a 
family; but neighborhood saved from this justly dreaded 
scourge. 

CONCLUSION. 

CHAPTER, XI. 

HTOIENE AND NURSING IN DIPHTHERITIS. 

From the partial paralysis of the muscles, which assist in 
the act of deglutition and the corresponding depression of 
piieu mo gastric nerve filaments, which regulate the action of 
the stomach ; the appetite at once becomes impaired, if not 
entirely suspended. And yet, from the very nature of the 
disease, breaking down as it does, the vitality of the blood; 
nutrition is ab-olutely essential in order to sustain failing, 
sinking vitality of the system. While it must be self-evident 
that the nutriment supplied should be in that form easiest 
swallowed, readily digested and most rapidly assimilated. 

CAUTION. 

The mouth, fauces and throat, should always be carefully 
washed out and freely disinfected, before swallowing any- 
thing. Non-attention to this simple caution, has been a 
proline source of mortality in this disease. Septic poison 
has thus been forced into the stomach, sent to the circulation 
aid thus has produced protopathic disturbance, if not organ- 
ic lesion. 

Have the patient always gargle mouth and throat well with 
warm water, in Which a teaspoonful of lister i ue has been 
placed, or an equal quantity of bromo-chloralum, or in ab- 
sence of both a few drops of carbolic acid ; and if it is not 
available, use equal parts of warm water and common vine- 
gar. If the patient cannot gargle use a clean cloth saturat- 
ed with the solution as a swab, and thus remove all loose 
accumulations from the mouth before swallowing even the 
smallest amount of any liquid, much less any solid. 



125 HYGIENE AND NURSING IN DIPHTHF.RITIS. 

I have as yet, never met a physician, 'or nurse who has 
ever given this caution an} consideration, hence, it has had 
ho place in practice, and yet from the very nature of the 
disease, and its local manifestations, we should naturally 
expect this simple caution would have been the very fiist 
consideration. 

As well feed the patient on broken down epithelium, or 
pus, as to compell him to swallow it with every 'drink of 
water, or every particle of food. 

After many years of careful observation, I am fully con- 
vinced, that more than one third of the mortality in this 
disease arises from an utter neglect of this caution. Mild 
cases have been rendered malignant, and malignant ones 

have been rendered incurable by the system thus becoming 
surcharged with poisonous matter, the accumulation of 

which could have been easily prevented, if this simple pre- 
caution had been taken. 

After the mouth has been thus cleansed the patients drink 
should always be acid, lemon water, lime juice, or water 
rendered acidulous by the addition of cieam of Tartar, may 
then be drank, ad libitum. 

THE DIET. 

This should consist almost exclusively of farinaceous food, 
corn starch, corn or oatmeal grewels, tapioca, sago, oyster 
soup, beef broth, chicken broth, mutton broth in which fine 
crackers or soda biscuit, has been well dissolved. The patient 
should be allowed to swallow no solid food so long as any 
ulcerative process can be found on the mouth or throat. 
When but little is taken at a time it must be frequently re- 
peated, and often changed so as to invite all the appetite poss- 
ible, as destructive metamorphosis has to be met by abundant 
nutrition, and this can only be done by a liberal supply of 
nutriment, easily digested and readily assimilated. The only 
restriction I have ever placed on liquid food, is on milk. I am 
not clear that this would be injurious, but on account of tin- 
excess in acids, I have thought it better not to use it, for 
fear of producing an indiirestable coaguhum in the stomach; 



HYGIENE AND NURSING IN DIPHTIIERITIS. 126 

while the eoagalttm produced by the normal g istric secre- 
tion of the stomach would be one thing, I apprehend the 
coagulum produced by the gastric secretion, aided by acid 
drink-, and the stronger acid of the remedial agent employ- 
ed, might be quite another thing; hence I never use or re- 
commend sweet milk in those cases. Batter milk 1 do not 
object to. In fact I recommend it, as nutritive, and in per- 
fect harmony with the acid treatment. 

NURSING IN DIPHTHERITIS. 

Every intelligent patient, especially every doctor, if sick , 
would much rather have a poor doctor and a good nurse, 
than a poor nurse and a good doctor. 

Suggestion, 1st. — It is indispensable that a nurse should 
not know too much. The great mass of professional nurses 
know infinitely more than the doctor, hence, assume the 
light to make any change in the room, the patient, or the 
medicine, or the amount or time of giving it, which they see 
fit, and thus cause the doctor, willing or not, to assume the 
responsibility of their unwarrantable interference. A nurse 
who will not implicitly follow the physicians directions, 
should be dismissed at once. I make it a strict rule of prac- 
tice, that such a nurse must be dismissed at once, or I re- 
tire from the case. No physician with any self respect, can 
continue in a case where such an interference is for one 
moment tolerated. 

The medical attendant alone can furnish instructions adap- 
ted to the peculiarities of each individual case : and it is the 
nurses duly faithfully to cany out these instructions, and as 
faithfully report at each visit the results of the treatment 
persued. 

2nd. The Sick-room.— The apartment should in all cases 
be dry and airy. The larger the room the better. The room 
should never contain less than one thousand cubic feet, and if 
the room is that small, there should never be more than the 
patient and nurse in it at once. A viciated atmosphere is 
to be depricated in any case; in this disease it is fatal. Win- 
dows should be slightly raised from the bottom and well 



127 HYGIENE AND NURSING IN DlPIirifERITIS. 

lowered from (he top, and if afire, ean be kept blazing in ihe 
room night and day, so much the better;' this is the best 
ventilation which can be obtained. The patients head mav 
be protected from a current of air or the direct heat of the 
fire by any reasonable device. 

During the existance of this disease, besides diluting a 
vieiated atmosphere with abundance of fresh air, dilated 
carbolic acid may and should be freely used as a disinfectant 
and a preventive to the dissemination of this disease; a so- 
lution of which should be sprinkled about the floor, bed, 
handkerchiefs, &c, &c; and the room well fumigated with 
the same, by a spray injector. It may and should be used 
as a personal disinfectant, by adding it to the water in which 
the patient is washed or bathe 1, a gargle of it purefies the 
breath and prevents the accumulated odor which is so often 
such an unpleasant accompaniment of malignant cases of 
this disease. Every person admitted to the sick room should 
be well saturated with the same solution, diffused by the 
spray injector. The addition of a little oil of cassia will ren- 
der it an agreeable perfume. 

3rd. The room should be provided with a second bed, or 
convenient couch. And to this the patient should be remov- 
ed atleast-once in twenty-four hours. This not only insures 
a change of atmosphere around the patients body, but it al- 
lows the bed to be aired as well. This affords a convenient 
opportunity to sponge the body, change the clothing, and 
add materially to the comfort of the patient. 

4th. The apartment should not be darkened so as to ex- 
clude air and light; but a subdued light should be secured 
if possible ; and the patients face and eyes should be protect- 
ed from the glare of the sun, fire and gas, or lamp light. 

5th. The sick-room should be kept quiet. Silk dresses 
and creaking boots should be carefully excluded from the 
sick-room. Even the rustleing of a news paper will frequent- 
ly distress a patient. The tone of the voice should be gen- 
tle and subdued. All unnecessay conversation should be 
avoided, and whispering never indulged in. 



HYGIENE AND NURSING IN DIPHTHERITIS. 128 

6th.. The temperature of the room should always be 
regulated by a thermometer. The sensations of a nurse are 
no criteria.11 for temperature. A thermometer suspended 
out of a direct current of air, and the direct heat of the fire 
will always indicate the correct temperature of the room. 
I have found from 50 ° to 70 c Fan.., to be about the pro- 
per standard. 

The air should be kept uniform and moist; and the bed 
covering* should be just enough to render the patient per- 
fectly comfortable, no more, and no less. 

7 th. The nurse must bear in mind that the patient is suf- 
fering from an infectious, contagious disease, and as such, 
should be separated as much as possible from all others ; an 
upper room is also best, as infectious exhalations, being 
lighter than air, always ascend, and thus the spread of the 
disease will be materially prevented. 

8th. Cleanliness. This is the sine qua non of all nursing. 
Linens should all be changed frequently; the body of the 
patient sponged thoroughly once every twenty-four hours, 
and immediately wiped dry ; unless acid is used, this should 
always be done with warm water rendered acid by the use 
of acetic acid, vinegar, nitro muriatic acid, or sulphurous acid. 

9th. Water to drink, or food to be eaten, should never 
be left in the sick room, or within sight of the patient. The 
air of the sick room will rapidly hasten putrefactive decom- 
position, and thus injure instead of benefit. 

As this is a disease of extreme prostration the patient 
should be induced to eat little at a time but often, and if 
swallowing becomes difficult enemas of milk, beef tea, mut- 
ton broth, &e, should be used. Nutrition must be secured or, 
an exhaustion of all the vital forces must follow, and death 
will be the inevitable result in spite of the best conducted 
treatment. 

As the atmospheric electric currents pass from north to 
south, I prefer to have the bed always stand with the head 
to the north and thus as far as possible equalize the circula- 
tion. 



129 HYGIENE AND NURSING IN DIPHTHERITIS. 

An extra blanket .should always be kept hanging on the 
foot of the bed, to be used in any sudden, unforseen change 
of temperature. 

The treatment given in these pages, as intimated, is not 
given as au infalable specific in all cases of this disease, in- 
dependent of contingent circumstances. The writer is a 
perfect unbeliever in ' 'specific curealls." Remedial agencies 
have a peculiar therapeutical and phsiological relation to 
certain normal or morbid pathological conditions ; and the 
more fully this relation is understood and intelligently rec- 
ognized, the more successfull will medical practice become. 

That all remedial agents should posses, what they do not 
now possess, viz., a chemical standard ol strength, is cheer- 
fully admitted; nay more, it is firmly insisted: but this 
chemical, standard, ''specific" strength, can never have 
anything to do with their "specific relation to disease, furth- 
er than uniformity of strength is concerned. We can only 
have "specifics" for disease, when we have, "specifics" of 
temperament, age, sex, idiosyneracies, pathological condition 
and contingent surrounding circumstances. As long as dis- 
ease continues to be modified by these, so long must reme- 
dial agents be modified, or changed to meet these peculiar, 
individual modify cations. Hence "specific medication," in 
this sense of the term is simply "specific nonsense." This 
treatment has been tested for years, with the best results. 
Has been carefully compared with the results of other prac- 
titioners, of all schools; and this comparison has always re- 
sulted in a verdict in favor of this treatment. This fact 
could easily be sustained, or demonstrated, by the unsolici- 
ted testimony of thousands, were it necessary. Such test- 
imony however, is only needed to sustain a feable cause. 

This must stand or fall on its own merits. 
When any practitioner, of any school, will present the pro- 
fession, and the world, with a more excellent way." I 
shall be happy to be among the first to tender my mede of 
praise and do him homage. 
Sub hoc signo vinces. 

THE END. 



ERRATA. 



On page 2 — 16th., and 20th., lines from top, and 3rd., line from bottom; 
also page 7 — 21st., line from top, and page 18 — 1st., line from top, read 
i^otnes instead of formes. 

Page 7 — 6th., line from top read steeped for stupid. 

Page 11 — 8th., line from top read sullen for sallen. 

Page 44 — 2nd., line from bottom read Neurine for nervine. 

Page No. 55 is omitted, though the reading matter is consecutive and 
correct. 

Page 56 — 23rd., line from top read Nasal for umihI. 

Page 110 — 12 h., line from bottom read sehool for scheol. 

Page 111 — 9ih., line from bottom read Ganglionic for gonglonic. 

Page 115 — 9th., line from bottom read die from a»phyxia. 

Page 116 — 2nd., line from top, inflammatory should have been spelled 
correctly as also on page 117 — 11th., and 12th., lines from top. 

Page 120 — 8th., line from bottom read a, instead of an healthy. 

Page 121 — 12th., line from top read prominently for prominantly. 

Page 121 — 8th.. line from bottom read a high grade. 

Page 123 — 3rd. , line from bottom jeopardize for jepardize, 

Page 126 — top line read coagulum for coagalum. 



